Finding My Way Out of Anti-Psychiatry: A Patient Perspective

Guest Post by Lisa Wallace

This is a guest post by Lisa Wallace, who explores critical perspectives on psychiatry through art and writing, taking inspiration from her encounters with the mental healthcare system and portraying both past experiences and the potential for improved mental health services.

Previously from Lisa Wallace:

Guest Post: A Psychiatric Survivor Comes to a Place of Understanding

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Original art work by Lisa Wallace

Criticisms of psychiatry run the gamut from expressing justifiable anger over individual treatment to outright calling for psychiatry’s dismantlement. I find it helpful to navigate these criticisms by understanding them as consisting of three overlapping groups: “prescribed harm,” “critical psychiatry,” and “antipsychiatry.” “Prescribed harm” refers to people who experience injury from improper medicating and then feel abandoned when seeking aid, but may also comprise those who view all psychotropics as toxic, dangerous, and unnecessary. “Critical psychiatry” is a broad phenomenon and refers to views ranging from improving care within existing treatment modalities to appeals for replacing what are viewed as oppressive systems to the formulation of alternatives, sometimes involving selling books, services, and training materials. “Anti-psychiatry,” the way I see it, is a complete rejection of psychiatry and includes former patients, those who’ve never been in treatment, mental health clinicians who reject psychiatry, influencers, political figures, religious groups, promoters of naturopathic remedies, and others. My descriptions are aligned with the general understanding of these terms online, but academics and scholars may find these descriptions to be oversimplified. Nonetheless, they’ll suffice for what I have to say. There are good and bad ideas in all of this, but all too often, generalized good ideas are plucked and then promoted in superficial, uninformed, and unrealistic ways.

I entered this world after decades of questionable psychiatric treatment that culminated in a psychiatrist discontinuing 5 medications without tapering. I joined in with heavy criticism of psychiatry, swearing to avoid any further treatment. I’m not in that place now, though I still voice more nuanced concerns. I’d been under psychiatric care, out of it, then against it, all the while on the fence about my bipolar diagnosis and need for medication, finally deciding to handpick a psychiatrist and return to treatment. This has proven beneficial. I’ve recounted my saga in more detail both in a past guest post on Psychiatry at the Margins and in my own blog Travels Through Psychiatry. Reading my personal blog from oldest to latest entries presents the full scope of my changing views, the why, the how, my frustration, and then hope.

As I reflect on my personal interactions with all sorts of critics of psychiatry and my participation in an online community consumed with attacking psychiatrists and their allies, I have gained certain insights. I found both pros and cons in being an active part of the antipsychiatry community. That’s what I wish to bring to light here, because, for me, unrelenting hostility helped in the short term, but not in the long term.

Communities that form around mutual assistance for those harmed in the course of psychiatric treatment are important and provide information, comfort, and advice. This part can’t be discounted, as patients often have nowhere else to turn. I found myself in that situation, dealing with physical problems, mania, and insomnia, while clinicians at the mental health center where I’d been treated dismissed my concerns and even denied that my medications had been rapidly discontinued by the psychiatrist (saying that I had become non-compliant on my own). This is a travesty, perhaps not representative of treatment experiences everywhere, but it’s maddening when it does happen. My rage intensified as I realized I’d been left on my own, and sharing that with others allowed me to openly scream about my pain. Processing anger turned out to be my first step in moving forward, even though I was unaware of my own progress. I imagined either always being a mass of symptoms or simply dying. Staying in solidarity with others like me, spouting anger, was enough gratification to keep me going one more day.

My rage intensified as I realized I’d been left on my own, and sharing that with others allowed me to openly scream about my pain. I imagined either always being a mass of symptoms or simply dying. Staying in solidarity with others like me, spouting anger, was enough gratification to keep me going one more day.

Eventually, I had my fill of wrath and fury. I took the vital step of recognizing that I was no longer in withdrawal from the abrupt discontinuation of psychiatric medications and that I needed to move forward. I began educating myself about all aspects of psychiatric treatment, and I was drawn to how psychiatry is changing. Some would assert that it’s not, but I was coming across more and more forward-thinking and enthusiastic psychiatrists, particularly in the younger generation. I pulled away from intense criticism, and, as I did, my eyes opened to the negative aspects of both my position on psychiatry and the potential damage inherent in certain critical and self-proclaimed reform movements.

My first revelation was that if I didn’t declare myself recovered from iatrogenic harm, I’d be entrenched in the identity of a shattered and sick psychiatric survivor. That didn’t suit me. I fear that people become trapped in that limbo, dissuaded from seeking out a better quality of life, boxed in and bitter, their faith dimming with each passing day. I understand and I sympathize, but my reaction is also one of intense sorrow. A picture flashes in my mind of a wounded animal snarling and biting when anyone reaches in to render aid.

Sadly, I’d spent a few years lashing out myself, mostly at mental health professionals on social media. I perceived them as enemies. Of course, none of them cared to engage in my antagonism, leaving me exasperated and in a cycle of hating, being turned away, hating more, and, in the end, only netting more loneliness. I’ve since become friends with some of those I once attacked; they are nice people, accommodating and polite, understanding of why I’d harbored such spite. They offer me secure space to discuss my life and how mental illness and treatment impact me; they read what I write, look at my art, and engage in conversation. If I hadn’t come around, I would’ve missed out on these positive relationships, never discovering that a return to treatment with the right psychiatrist would enrich my life. Bipolar disorder is a part of me that, if left untreated, crushes my identity and hopes, even if I wish to deny it.

My first revelation was that if I didn’t declare myself recovered from iatrogenic harm, I’d be entrenched in the identity of a shattered and sick psychiatric survivor… I’ve since become friends with some of those I once attacked. If I hadn’t come around, I would’ve missed out on these positive relationships, never discovering that a return to treatment with the right psychiatrist would enrich my life.

Losing one’s self is bad enough, but the most notable con of participating excessively in psychiatry criticism is encountering cons. By that, I mean people who present as leaders in alternatives to diagnoses and who advocate for trauma-focused therapies over medications for everyone, or who say that mental illness is nonexistent, a false construct that disappears with proper diet and exercise, or who overstep their training to invent new programs, new paradigms, new ways. They capitalize on reasonable ideas for change, ideas that are hard to argue, but they fail to demonstrate a full understanding of the experiences of people living with mental illness. They fall short even as they draw in tens of thousands of followers with promises of holding the keys to a revolution. Sometimes they mask their intentions to run roughshod over psychiatry by stating that it’s just an alternative. And they often end up lacking in engagement, disconnected from their audience, excluding the seriously mentally ill, or appropriating work started by those with lived experience.

Once, I attended an online event celebrating one such alternative proposal. I liked parts of the talks and found them inspiring, so I was eager to join the question-and-answer session at the end. But the organizers appeared disinterested in any meaningful engagement. They came across as smug. They were sitting at their computers with glasses of wine visible to all. I’m in recovery from alcohol and drug misuse. This struck me as wildly inappropriate for their audience, an inability to read the room. I wondered how they could assist people struggling with multiple issues and disorders with such an attitude of detachment.

I’ve also observed authors of these new paradigms asserting opinions way out of bounds of their training and clinical experience. I’ve heard preaching about organic diets when that type of food is either inaccessible or unaffordable for many with mental illness. I’ve read posts expounding on mental illness as an invention of the patriarchy and witnessed more harping by these critics on the “chemical imbalance theory” than anyone in psychiatry ever did. Some of the rhetoric is just silly, but some is dangerous, urging mentally ill people to deny themselves treatment, and some is insulting to patients who are broken down, disorganized, and unable to function as they are told their problems are all about lifestyle, unaddressed trauma and social problems. Their interest isn’t in working with current treatment systems to slowly bring in change. Plans for implementation and transition, funding, and ways of working with politicians are absent. But they’ll sell you a book or a lecture series and invite you to listen to their podcasts. To me, it’s all schemes, removed from the reality of patients’ needs, how treatment is financed, and how society operates, regardless of idealism.

I’ve witnessed most of this behavior on social media. To be fair, communication in these online platforms limits the depth of presentation of ideas. However, constantly putting out dashed-off statements – intended to be provocative and possibly intended to be misunderstood – is irresponsible, especially knowing that people will be left without a full understanding. Without mentioning any specific posts, I’ve read posts saying that schizophrenia is an expression of trauma, or that diagnoses and medications are a plot to hook patients for life, or even that certain mental disorders didn’t exist before they started being named. Any challenges to false claims are met with cries of being misunderstood or persecuted for telling the truth. Requests for clarification may garner an invitation to come debate on a podcast that lacks legitimacy and is staged for the podcaster to triumph as the good guy.

People facing their own mental illnesses daily, knowing their own internal struggles, are caught in being once again disregarded or belittled or shamed for not doing all the right things. They read it as failure if they don’t have an exercise regimen, don’t get enough sunshine, don’t eat the right diet, don’t reject medication, don’t think of their illness as wrought by family and society, or if they neglect to scrutinize psychiatry at every turn. I find this horrible. Grappling with mental illness is like walking a path that is never clear; the complexities of mental illness are rarely addressed in a few solutions, and recovery depends on ongoing care. I’ve had times when I thought my bipolar disorder was gone, but that turned out to be an illusion. To suggest that simple answers remove all the complexity, plus the illness part, from mental disorders is essentially to abandon the very needs of people suffering from them.

If I had become totally committed to a rejection of psychiatry or to some misguided ideological alternative, I would have been stifled as a person and my growth into a healthy and rounded individual would have been stunted. Other people would have spoken for me, and in ways not authentic to me, peer pressure keeping me attached to and lauding what doesn’t deserve much praise. Ultimately, I realized that there are no perfect ways or formulations for helping people through mental illness or crisis or coming to terms with trauma. Every treatment plan is unique to the individual and often, without medication, without hospitalization, patients are not only at risk, but unable to muster anything beyond basic survival. That’s not a truth I feel should be played with, because it endangers those who are vulnerable.

I switched from an anti-psychiatry stance to one characterized by an informed respect for psychiatry. It was a difficult process for me, requiring me to process my justified rage from psychiatric mistreatment and requiring me to employ critical thinking skills and engage in self-education, but the ultimate release from repetitive criticism and unjustified hostility has been worth it for my growth and well-being.

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See also:

The "Antipsychiatry" Dilemma

Antipsychiatry as an Analogue of Populism

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