General Introduction to the Study Guide
This reader is a study guide and a work book for those who are familiar with some ideas, images, or theories of madness or “mental illness” (and perhaps also psychiatry), but feel a lingering skepticism and doubt about what they mean. What are the first images that come to your mind when you think of the word “madness?” If it’s more familiar, go ahead and substitute the word “insanity” or “craziness” for “madness”. What about “mental health,” “mental disorders”, “chemical imbalances”, and “delusions”? Can you think of any other words that seem related to these, but are missing?
It is more important than ever that we all talk about what “mental health” is and how we relate to it. Let’s look at some basic facts. The number of people who are diagnosed with a mental disorder is steadily growing every year, especially when looked at globally. According to the World Health Organization (WHO), over 450 million adults have a diagnosable mental disorder worldwide. They also report that the number of suicides increased by 60% over the last 45 years. Mental disorders apparently account for “8.8% and 16.6% of the total burden of disease due to health conditions in low- and middle-income countries“. So, something must be done, right? We need “more mental health services”, as many activists and others are apt to say. But what does that mean? Medication? Yoga classes? More hospital beds? Free or affordable therapy?
Calling for “more mental health services” starts to look somewhat questionable when one looks at a number of other facts. In the 1970s, WHO found that those diagnosed with schizophrenia —often called the most debilitating of all mental disorders— fared better in developing countries than in the U.S. In a repeat of this study, they found the same results. A number of follow-up studies found that patients who had weaned themselves off the antipsychotics, which were supposed to “fix their brains” had fared much better than those who continued to take them. When faced with these facts, simply calling for “more mental health” starts to look unsatisfactory.
We also live in a time when patient-centered groups, and groups of those who identify with unusual experiences typically seen as “crazy” (hearing voices, extreme mood expressions, seeing things, having “strange beliefs”) organize themselves in social groups, study groups, support networks, and antipsychiatry activist groups. The mere existence of such groups already wears upon the more extreme claims made by psychiatry that, for instance, “psychotic” patients will flounder in their undertakings and live solitary lives trapped in a world of fantasy. This uneasy feeling deepens when we see that some such groups have publicly accused psychiatric treatment to be unhelpful, unnecessary, and, in some cases, torturous. Others have argued that psychiatry is operating as nothing more than a police force, incarcerating the unwanted or unsightly from the streets to sedate them or simply hold them in hospitals or asylums out of sight, and, for their less unsightly patients, providing simple drug fixes to the complex problems wrought by political and economic systems.
This is a very personal document for me. I have heard talk about this thing “madness” for as long as I can remember. Multiple members of my family have undergone interventions for their “madness.” Sometimes that meant taking pills; sometimes it meant getting taken away to a hospital or treatment center against their will; other times it meant going to those places willingly; but it always meant that the person diagnosed and the people closest to them had to rethink their life, their personality, and relationships. I too have undergone psychiatric intervention in my life, unwillingly and willingly. The effect these treatments have had on my life is immense. I have also had a number of bizarre or extreme experiences, which, up until recently, I had always been afraid or felt unqualified to talk about, in large part due to my feeling threatened and delegitimized in my experiences with psychiatry and clinical psychology.
This study guide is for those who feel similarly doubtful, uncertain, or uneasy about the way we talk about “madness” or “mental disorders.” It’s for those who have been diagnosed, hospitalized, and drugged and feel like their psychiatrist doesn’t know best, but they aren’t sure how to express that; it’s for those who have seen a family member or friend “treated” for mental illness and were confused or dissatisfied by the process; it’s for those who have never had interface with psychiatry, but feel like madness or mental illness has touched them, and they don’t know what to make of that feeling; it’s also for those who feel like they know enough about mental health, and what to do about it. They won’t find any easy answers here. This guide is not structured so that the reader will walk away with a cohesive ideology or belief; it was made to initiate and facilitate a process of questioning and doubt, and hopefully of discovery.
My hope is that people use this guide either for self study or for aiding in the formation of critical mental health reading groups or film groups. The reader is organized into 10 units. One could either decide to study a little bit from each unit, focus entirely on a unit of particular importance to you or your group, or do the entire thing. At the beginning of each unit, you will find a summary of the themes and questions explored, and, at the end, a couple questions you are invited to use as a note-taking device. Most will have a primary text to introduce the themes and ideas in a general way. This will be followed by a few optional texts, podcast episodes, films, or other media that go deeper into the themes. There will be hyperlinks for all the texts, podcasts, and more on the pdf (with the exception of the films, which you will have to find on your own). As a rule, the main text and materials will be shorter and more like a survey of the problem/question of that unit. The optional texts will either be primary documents or somewhat denser secondary texts illuminating one or two aspect of the general theme. In many cases, the primary texts are interviews or surveys of a theme.
The units and the optional texts within them are merely suggestions, and, if excluding something, mixing-and-matching, skipping units, or changing the order would help facilitate your understanding, please do it. The LISTEN, SEE and WATCH sections offer podcast, song, art, and film recommendations for opportunities for learners of different types to use what they feel most comfortable with to approach the questions at hand. A general warning for what is to come: we have not excluded texts which discuss many unpleasant and challenging topics including child abuse, suicide, self-harming, and rape. Please use your own discretion as you continue.
Every section will feature at least one text or work by a person who feels they have passed through/live with “madness” or has had a psychiatric label forced upon them. This is necessarily a difficult category to pin down, as you shall see. I let the writers themselves define what it means to them to be mad, and did not use any diagnostic system or nosological schema (classification system for defining and organizing diseases) to decide who warranted inclusion or not. I see such people as primary authors and thinkers on the pathway to understanding and not as case studies for one to examine at a distance (as if there are the works by the “normal” authors about madness and then ones by crazy people for one to check their ideas against).
I’ve designed the guide in three parts with a particular narrative structure in mind, even though the parts as I’ve conceived them will blur into one-another. The first part is largely negative, in that it is meant to challenge dominant beliefs about mental health. Sometimes this is done through critique, other times it is done through illuminating alternatives to the normal, accepted ideas. The world seems over-saturated with ideas and facts about mental health. This “ever more facts” model serves above all to bury the essential problems related to madness under a mountain of detail. So first, this guide will challenge beliefs already held by most people in American society, and since most of these beliefs come from psychiatry (directly or indirectly), the first half will largely be about psychiatry and the process of labeling and treating someone as “mad” (roughly units 1-5); the second cluster of units (units 6-7) will then offer up unique perspectives on “madness,” will outline some reform and harm reduction efforts of the past and present within psychiatry, and potential alternatives to our practices of “mental health;” the last part (units 8-10), will focus on the experiences of those who have experienced something they’ve called madness, and will look outwards, to try to draw connections and remove the question of madness from its imposed isolation in medicine and draw new lessons from it. The entire guide is permeated through and through with the voices and experiences of the “mad”. Through their voices, I hope that readers will experience a guided, soft, break down, because it is only by breaking down that we can open up space to hear those voices that are desperately calling out for us to listen.
Below, I will include books and texts that were either too long, or cost money so that they didn’t make it into the final copy of the bibliography. I will continue to add to this list. The “units” correspond to those in the bibliography, to make it easier for anyone who wanted to follow up on a particular idea or interest.
Suggested Further Reading
- Escher, Sandra; Hage, Patsy; and Romme, Marius, “VOICE HEARING: A QUESTIONNAIRE”, http://www.hearingvoices.org.nz/attachments/article/59/Maastricht_Interview_for_voice_hearers.pdf
- Leudar, Ivan and Thomas, Phillip, Voices of Reason, Voices of Insanity: Studies of Verbal Hallucinations, London, Routledge, June 22, 2000.
- Luhrmann, T. M.; Padmavati, R.; H. Tharoor and A. Osei “Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study”, Luhrmann.net, April 3 2014, http://luhrmann.net/wp-content/uploads/2012/02/bjp-hearing-voices.pdf
- Morin, Roc. “Learning to Live With the Voices in Your Head”, The Atlantic, Nov 5, 2014, https://www.theatlantic.com/health/archive/2014/11/learning-to-live-with-the-voices-in-your-head/382096/
- Scull, Andrew. Madness in Civilization: a Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine. Princeton University Press, 2015.
- Thiher, Allen. Revels in Madness: Insanity in Medicine and Literature. University of Michigan Press, 1999.
- Conrad, Peter. Medicalization of Society: On the Transformation of Human Conditions Into Treatable Disorders. Johns Hopkins University Press, 2007.
- Greenberg, Gary. The Book of Woe: the DSM and the Unmaking of Psychiatry. Plume, 2014.
- Littlewood, Roland, and Maurice Lipsedge. Aliens and Alienists: Ethnic Minorities and Psychiatry. Routledge, 2014.
- Metzl, Jonathan. The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon, 2011.
- Warren, Carol A. B. Madwives: Schizophrenic Women in the 1950s. Rutgers University Press, 1991.
- Biehl, João. Vita: Life in a Zone of Social Abandonment. Univ. of California Press, 2008.
- Foucault, Michel. History of Madness. Edited by Jean Khalfa. Translated by Jonathan Paul Murphy, Routledge, 2009.
- Foucault, Michel, Psychiatric Power: Lectures at the Collège de France, 1973–1974, Picador; June 24, 2008. Retrieved from: http://rebels-library.org/files/psych_power.pdf
- Whitaker, Robert. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Basic Books, 2010.
- Gilman, Sander L. Disease and Representation: Images of Illness from Madness to AIDS. Cornell University Press, 1994.
- Mills, China. Decolonizing Global Mental Health: the Psychiatrization of the Majority World. Routledge, 2014.
- Mirowsky, John, “Subjective Boundaries and Combinations in Psychiatric Diagnoses”, The Journal of Mind and Behavior, Summer and Autumn 1990, Volume 11, Numbers 3 and 4, http://www.brown.uk.com/brownlibrary/MIROWSKY.htm
- Cooper, David. Psychiatry and Anti-Psychiatry. Routledge, 2013.
- Hornstein, Gail. To Redeem One Person Is to Redeem the World: the Life of Frieda Fromm-Reichmann. Other Press, 2005.
- Laing, R. D. The Divided Self: an Existential Study in Sanity and Madness. Penguin Books, 1969.
- Romme, Marrius A. J., et al., editors. Living with Voices: 50 Stories of Recovery. PCCS Books in Association with Birmingham City University, 2013.
- Cvetkovich, Ann. Depression: a Public Feeling. Duke University Press, 2012.
- Frame, Janet. Faces in the Water. Women’s Press, 2000.
- Gotkin, Janet, and Paul Gotkin. Too Much Anger, Too Many Tears: a Personal Triumph over Psychiatry. HarperPerennial, 1992.
- Burstow, Bonnie, et al., editors. Psychiatry Disrupted. Theorizing Resistance and Crafting the (r)Evolution. McGill-Queen’s University Press, 2014.
- Hall, Will. Outside Mental Health: Voices and Visions of Madness. Madness Radio, 2016.
- LeFrançois, Brenda, et al., editors. Mad Matters: A Critical Reader in Canadian Mad Studies. Brown Bear Press, 2013.
- Shimrat, Irit. Call Me Crazy: Stories from the Mad Movement. Press Gang Publishers, 1997.
- Deleuze, Gilles, and Félix Guattari. Anti-Oedipus: Capitalism and Schizophrenia. University of Minnesota Press, 2008.
- Sass, Louis. Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. Harvard University Press, 1994.
Header image is of Agnes Richter’s jacket in the Hans Prinzhorn Collection in Heidelberg, which is art works created by past and present psychiatric patients.