AN ANTIPSYCHIATRY FAQ

03/2025 - for a prison abolitionist, psych abolitionist, pro-drug, communist perspective.

Notes:

1. Antipsychiatry (which I also refer to as psych abolition here) is an extremely broad term which has encompassed a vast amount of opinions and approaches, from conservative, from communists, and from actual scientologists, since the 1950s. When people ask what antipsychiatry thinks about one topic or another, I assume they are asking for my personal opinion and perspective, necessarily limited by my experiences; you will always find someone who places themselves within the antipsychiatry movement that thinks the exact opposite. For this reason, you will probably find in most of the books I recommend here some positions or arguments that I (and you) disagree with. I still find them useful sources and points of research.

2. The aim of this document is less to provide specific answers to all of the standard introductory questions about psychiatry and more to offer ideas for consideration and a matrix of thought that can then be applied broadly to other more specific questions you might have. The questions are divided according to six main themes that cover many of what I perceive to be central tenets of antipsychiatry: diagnoses and the DSM/ICD, the medical establishment – knowledge and authority, pharmacological drugs, disability justice, carcerality and the psychiatric hospital, and normality/neurotypicality under capitalism. Though each section (and question) can be read independently, many concepts outlined in part 1 and 2 specifically are referenced in other sections. Many of the recommended readings also apply to various of the themes outlined here, but were organized according to the one they were most immediately applicable to.

1. Diagnoses and the DSM/ICD

Recommended readings: “My Doctor is Lacking Insight”: Alternative Experiences of Insight in Mental Health on Psychiatry is Driving Me Mad.

You’re saying psychiatric disorders are not real. Are you saying I’m making it all up, should just stop complaining and get to work?

It is important to state something here that will come back several times throughout this document: when we say that psychiatric diagnoses or mental illnesses are not real, what we are referring to is their classification according to psychiatry, and their description as objectively correct, scientifically observable illnesses. The impossibility to get out of bed and to function is real. Your debilitating fears are real. Your struggle to behave in socially acceptable ways is real. Your hallucinations are real. Our aim in questioning the structure of the diagnosis is not to place the blame on the patient, or to interrogate the reality of these feelings and behaviors (such as in the antipsychiatry tradition of Thomas Szasz, for example) but to analyze the systems and contexts that cause (or exacerbate) those symptoms, which the diagnosis only serves to obscure.

It is not because a doctor looked at you and assigned a psychiatric label to your suffering that your suffering is real; it is because you are experiencing it. Of course, if we go further, doctors having assigned you that label does not in any way guarantee that you will be taken more seriously, or that your suffering will be legitimized. That (heavily conditional) legitimization depends on many variables and can be revoked at any moment, for example for noncompliance.

Ok, so what do you mean, then?

When you refer to an illness, you refer to a phenomenon with a specific cause behind the symptoms. Covid is caused by being exposed to the virus. Salmonella is caused by ingesting undercooked or unpasteurized food. We might not always know the cause to an illness and wrong diagnoses do happen (for similar criticism on other branches of medicine, see part 4), but these diseases refer to specific biological processes that unfold. Psych diagnoses, on the other hand, refer only to a collection of symptoms: you have Bipolar Disorder because you behave in x or y way (or rather, because a psych professional perceives you as behaving in x or y way), and why do you behave in x or y way? Because you have Bipolar Disorder. Nothing however has been explained through this process, about your struggles, about what causes them, or about possible cures; the logic behind it is the snake biting its own tail.

For people who have long been exposed to psychiatric logic, this claim might seem on par with asserting that gravity is not real, bringing many accusations of science denial. But psych diagnoses are recent; their classification, and the symptoms that inform their diagnoses, are ever-changing (and vary wildly even from country to country and school to school). In fact, despite common claims to the contrary, a singular, unified biological (hormonal, neurological, etc.) cause for any psychiatric diagnosis has never been found (see part 2). Therefore, a psych diagnosis, in itself, refers only to a collection of behaviors that are grouped together and then constructed to form a disorder. This disorder has no inherent existence outside of the taxonomy scheme that created it, and no explaining power as to why you are experiencing what you are experiencing.

When I refer to psych diagnoses as not being real in the rest of this document, this is what is mean.

Sure, we haven’t found it yet, but what if there is a biological cause to psych diagnoses?

Then I could say that any person who likes the color blue has a disorder called kyanophilia. It is now a distinct entity that exists. We don’t know yet what causes it, but we will one day. Of course, though, this would not happen; the behaviors or sets of behaviors that get classified as psych diagnoses are those that impede functioning according to capitalistic expectations and/or threaten compliance to its rules. The reason Eating Disorder diagnoses exist, for example, despite society being structured around fatphobia and injunctions to weight loss, is that going too far in your weight loss obsession stops you from being a productive member of society. In order to think that there is a potential biological cause behind Anorexia for example, you have to think that the behavior of intentionally-not-eating, regardless of its context, its causes, its individual manifestations, has an existence of its own and is caused by specific factors (or, in more generous but still incorrect versions, a fixed variety of possible factors). This also applies if you think that the factors are partly biological and partly social, or informed by your environment; the issue is not in the cause of the disease, but in the existence of a disease as an entity that can be objectively observed.

It is also important to note, furthermore, that psychiatric diagnoses are not made by looking at someone’s brain imagery or running a blood test: they are made by a psych professional looking at you and talking to you. The diagnostic criteria used for that purpose is left purposedly very vague (the DSM criteria for ADHD lists “overly talkative” or “displays poor listening skills”, which can believably apply to anyone) and based fully on how that professional feels about you, with their biases, opinions, and ideologies. Two psychiatrists will often diagnose the same patient with completely different disorders (and due to the structure of diagnostic tests, two people diagnosed with the same disorder will often have no symptom in common), which is a feature, not a bug: since psych diagnoses are a collection of symptoms, two psychiatrists with different opinions will simply observe or interpret their patient’s behaviors and thought processes differently, depending on how they parse them and what they hope to achieve through this diagnosis. This does not mean that one is right or the other is wrong: this means that there is no objective existence to the categories, beyond subjective symptoms. It is true that certain diagnoses are more likely to be applied to certain populations / certain drugs prescribed to certain people (trans people and CSA survivors prescribed antipsychotics, schizophrenia as a Black disease). However this cannot be corrected by doing sensitivity training to doctors so they do not "misdiagnose".

Why do diagnoses exist, then?

Because they serve a purpose to the medical establishment (see part 2) and to structures of power in general. For medical insurance providers, they serve as billing codes in order to standardize how to charge patients; from a social point of view, they are part of a classification effort that medicalizes deviance by assigning names (and pathology) to various socially unsanctioned behaviors (the DSM itself mentions explicitly for a diagnosis, “Note: Do not include a symptom if it is a culturally sanctioned response”). For psych professionals, the diagnosis they give each patient is what they believe will be most useful to ensure their patient complies with social norms or gets incarcerated, becoming more manageable, one way or another.

This doesn’t mean anyone is sitting in a dark room plotting on how to make psychiatrized people’s lives as miserable as possible. They might be fully convinced that they are providing care and doing what’s best for the patient. They are, however, acting in accordance with the carceral logic inherent to psychiatry and capitalism as a whole.

While every diagnosis is different and arose due to different forces, this matrix of understanding can then be applied to broadly the existence of every psychiatric diagnosis.

If psych diagnoses aren't real, then why are people experiencing them according to the patterns described by the DSM? Why did I fit the (x) diagnosis definition perfectly before ever hearing about it?

For a variety of reasons. Psychiatric diagnoses refer to quite common clusters of symptoms (if you experience intense moments of obsession where you don’t sleep for days [“mania”], it’s likely that you will have a no-energy crash after [“depression”]); the diagnosis definitions, as mentioned, are often meant to be as vague as possible; due to the treatment of psychiatrized people and deviance in general in capitalistic society, people often find comfort, validation, and of course material support in recognizing themselves within the parameters of various disorders, which explains the intense reaction that many people have in seeing this be questioned. Diagnoses and trauma can be expected to be used as bargaining chips for social capital – a dangerous rhetorical move that people are sometimes expected to play. Medicalization is also seen as the only path to liberation, in a clear parallel to some trans political movements who, in order to justify access to transition, insist on male/female brain differences and gender dysphoria as a medical disorder.

Yes, I agree! People get psych diagnoses wrong because of pop psychology. Everyone thinks they have (x) diagnosis these days and that their parent was abusive because they had (y) disorder, which leads to stigmatization of those diagnoses.

This assertion still rests upon the idea that mentally ill people form a coherent, pre-discursive category that is unfairly maligned – that there is such a thing as, for example, Narcissistic Personality Disorder; the problem is in people referring to their abusive parent as "a narcissist", which is unfair to people who really have that illness. This is a common issue when discussing the destigmatization of mental illness: it implies taking the psychiatric worldview as a given, and also getting the process backwards. It is because "narcissistic" as an adjective refers to someone who is self-obsessed and harms others that the diagnosis got its name; the diagnosis, of course, then proceeds to reinforce and create further negative meanings in the adjective. The diagnosis criteria (“a demonstration of arrogant and haughty behaviors”, “a sense of entitlement”) belies the same worldview: that there are people who inherently can’t be trusted, due to something in their intrinsic nature, and that the only question is how to identify them correctly. Teenagers on TikTok diagnosing their ex with "pop psychology" understanding of terms are using the terms exactly as they are used in a clinical setting: to describe someone perceived as off-putting, potentially violent, and impossible to reason with. Someone with a clinical NPD diagnosis does not “really have” NPD any more than this hypothetical ex – or only in the sense that they have been put in a social category that makes them more vulnerable to violence and loss of autonomy, but this says everything about society’s reception of them (often tied to factors of race, class, gender, ability status, etc.) and nothing about any truth inherent to them. In the end, no one should receive this label, clinical setting or not, and we should not accept these labels as describing someone’s permanent, incurable (especially in the case of labels associated with psychosis, and so-called personality disorders) self. We should instead interrogate ourselves on whether we derive our claims to legitimacy from psychiatric knowledge, what ideas this knowledge is constructed upon, and whether clinical validation of experiences is an ideal we must aspire to.

Diagnoses help people, though. They help describe your experiences, find resources and community and know that you’re not alone. How else would I describe my experiences?

That is true to some extent; the specific diagnoses you were assigned do inform (among other factors) your experiences, and using it as a shorthand to describe them can be useful. Someone diagnosed with Schizophrenia as a young child and put through the abuse of special education as a result might want to use that label to talk about those experiences. The issue comes when people start considering that the diagnoses are revealing some internal truth about themselves (or, more egregiously, their brain biology), instead of about systems of power.

When people try to spread “accurate” information about common psychiatric or psychological terms (gaslighting, intrusive thoughts, sociopath, psycho, etc.) they often do it in a way that seeks to rescue these terms from the rabble’s bastardized understanding. What is lacking here is a critical attitude towards the reasons those terms exist. It is always useful to constantly question those terms and their definition(s): what are they basing this definition on? Who created this definition, based on what assumptions? Since when has there been an understanding of this term as forming a coherent category, and among whom? What do they imply about permanence and unity of the self? Failing to follow these trains of thought leads to reifying psych diagnoses, their taxonomy, and their application to people, such that a challenge to psychiatry reads as a challenge to the self.

Are you anti-recovery?

Recovery is not a neutral term. In a clinical setting, it often implies a specific path that, once again, is meant to ensure compliance and ability to work. Many psych professionals, for example, will refuse to treat a patient who is not sober (regardless of their personal relationship to substances and regardless of the fact that psych medications are also psychoactive substances, see part 3). I am in favor of all people being able to access treatment on their own terms and having their needs met – this is, however, to a great extent, mostly out of people’s control under our current system. A positive attitude does not get someone out of an abusive living situation or poverty wages; what does help someone in those situations is a strong support network and autonomy to make their own choices (though these are of course only limited solutions under capitalism), and not condescension (by psych professionals or otherwise) about the wrong, self-harming decisions they are making. For a shameless self-citation, I wrote more about this topic (and about the category of self-harm in general) here.

2. The medical establishment: knowledge and authority

Recommended reading: Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness by Anne Harrington. Recommended video: Myth of the Chemical Imbalance.

But what about (x) study, which proved that we have reasons to believe hormones or the brain are caused by (y) diagnosis? My doctor showed me an article that says that (z) has been proven by science, so you’re incorrect.

I wanted to start with this point, as it gets brought up a lot on discussions regarding psychiatry, medicine, and science as a whole. The assumption here is that any claim made by a medical professional (or, often, reported by a third party from a medical article) is correct, and that beyond that, any layperson will be able to infer the consequences and context of these claims correctly. There are many reasons you should be wary of any broad claim you hear about psychiatry. One, studies are often funded by pharmaceutical companies trying to find a “chemical imbalance” so they can better sell their product as correcting that imbalance. Two, a singular study, with a limited sample, cannot prove or disprove any claims about the brain of “people diagnosed with ADHD” as a whole, since, once again, the diagnosis is not made by observing the brain, but by observing the patient’s behavior. Three, the methodology used in those studies is often poor and subjective (how do you objectively measure and compare people’s depression? How do you measure it in animals? How can you replicate life circumstances in a clinical setting? How can you account for other factors?). Four, medical professionals simply lie to their patients quite often. It is unlikely you will be told about the physiological effects of the medicine you are prescribed before taking it. Five, the claim that we have definitely, completely, for sure found the biological cause for (x) diagnosis now has been made for more than a century – the specific biological marker that is blamed this time around depends on the needs of the psychiatric establishment, drug companies, and contemporary racist, sexist, and homophobic narratives. I recommend familiarizing yourself with some useful medical literacy techniques (who wrote the article? How big was the sample? What were they testing for? Do the results of the study necessarily mean what the abstract claim they mean? Are they leaping to unsupported conclusions? Were they other studies that obtained the same result? Could the results be caused by other factors, and were they accounted for? etc.) so you can more effectively parse information for yourself.

In short, there is no “ADHD brain”, identifiable cause for schizophrenia, chemical imbalance that causes depression, or any biological marker linked to any diagnostic of mental illness: any study making claims to the contrary should be taken with a heavy grain of salt. The question of causality is also fraught:

Even if there were evidence of this sort, it would not demonstrate that the biochemical aberration was the cause of the psychological state. It might just as well be the consequence, or merely the correlate of the subjective experience, and it is surely simplistic to assume that there is a one-to-one relation between our complex emotions and biochemical states. For example, we know that adrenaline, the 'fight or flight' hormone as it is known, is produced in situations characterized by many different emotions. It is produced when someone is feeling aggressive during a fight or a battle, when someone is frightened, acutely anxious or euphoric. It hardly makes sense to say that adrenaline is the cause of these varying emotional reactions. It is better to view it as the body's response to a situation involving increased arousal and as such it is a correlate of many different emotions.

The Myth of the Chemical Cure, Joanna Montcrieff

The issue is with outdated diagnoses (hysteria, drapetomania) and treatments (lobotomies, electroconvulsive therapy); but psychiatry has evolved since then, science has progressed, which proves it is reformable. Are you anti-science?

ECT (and many other practices generally thought to have vanished) is still practiced today. In any case, however, this view of science as going in a progressive direction, as a matter of slowly discovering more and more of a sum total of genuine knowledge through theory and experimentation (known as positivism) is one of the ways in which it legitimizes itself and fends off criticisms: this was then, this is now. This is very visible in psychiatry (see the rest of part 2, and part 3) but also applies to the rest of scientific and medical fields. The poster children of outdated, “bad” psychiatry (the unhappy 1950s housewife being prescribed heavy doses of Valium, or the 1930s sexual abuse survivor being labeled hysteric and locked up) were not accidental mistakes that have since then be corrected. The purpose of a system, as they say, is what it does: they were cases of psychiatry functioning exactly as intended, as a means of social control. Of course, psychiatry must present itself as having corrected those errors, and uses these examples as proof of that. What about the current diagnoses, in the DSM-V, of Oppositional defiant disorder (applied to children questioning authority)? Gender Dysphoria (pathologizing gender non-conformity)? Persistent Complex Bereavement Disorder, though only suggested in the DSM (applied to people thought to grieve for “too long”)? What about psychiatry endorsing genocide and medicalizing dissent, constituting acts of resistance in Palestine, for example, as indicative of a mental illness? Science as a discipline serves the interests of the ruling class; if we are interested in learning more about the workings of the human brain and how to ease suffering, the current institution of medicine accomplishes neither of these goals.

I’m a med student/psych professional/social worker and I’m trying to change the system from the inside.

It is a very, very common rebuttal attempt that it is possible to be a good therapist, a good psychiatrist (indeed most of antipsychiatry proponents from the 1960s onward were themselves practicing psych professionals), to respect patient autonomy, etc. The question of whether it is possible to be a good participant in an oppressive system (and of our respective responsibilities within this system) is a broader one, but it must be noted that it has nothing to do with the criticism of a system as a whole. Even if we accept the premise that it is possible to separate an individual from the broader system in which they work, as a good therapist, if your client is having an episode and talking about killing themselves, will you report them to the hospital? Will you be ready to lose your license if you don’t? What will you do if your colleague forcibly incarcerates one of their patient for refusing to take neuroleptics? If you work in a hospital, what do you do if you get instructed to put a patient in solitary confinement? What do you do when a patient openly hates you and doesn’t trust you, or hits you while you are trying to restrain them? None of those are hypotheticals – they are in fact very real situations to which you will consistently be confronted, regardless of the specific setting (private practice, hospital, corporate setting, non-governmental organization, social work, or other) in which you operate. Being a psychiatrist or therapist that fully respects patients’ autonomy is simply not possible, in the same way that being a prosecutor who makes decisions fairly and impartially is not possible: because it is not the way that the office is designed, and because you have the choice to either comply or eventually lose your job. Psych professionals who think of themselves as committed unconditionally to autonomy and dignity simply have a narrower scope of what this entails and still operate under the logic that some people just can’t be reasoned with and must be forced into treatment – based on their judgment, of course (see part 5).

But my therapist is nice.

This is tied to the previous question, and is often offered to people who are exchanging stories about the horrors they have endured at the hands of psychiatry, to show that they simply had a bad therapist, and they should find a better one. Beyond the cruelty of such a statement, it operates under faulty premises. As with everything currently considered a treatment option under psychiatry (mainly therapy and medication), everyone should be free to access them and use them on their own terms, while aware of their effects and possible risks. In the case of therapy, that includes being aware that no matter how nice your therapist is, how trauma-informed or leftist or queer, they can and will report you (and would lose their license and face charges if they don’t) if you behave in ways they consider a danger to yourself or others, which can lead to, for example, police involvement, conservatorship, incarceration, loss of custody of your children or interrupted access to hormonal treatment. How would your nice therapist react if you admitted to taking criminalized drugs? If you refused to take their medical advice? If you had irreconcilable ideas about reality?

If you think that this wouldn’t happen to you because you’re not like those mentally ill people, think that any “normal”, stable person is one crisis they can’t solve away from potentially becoming one of them – but that the fact that it could and would happen to you should not be the basis on which you form your opinions on how people are treated. If you think this only happens to people who deserve it and for which no other means would work, think about your understanding of deserving, and of the ideologies behind it being presented as a solution (see part 5).

3. Psychiatric medication

Recommended readings: The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment by Joanna Moncrieff and Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker. Recommended video: No Known Biological Causes.

But drugs help me, though. Are you staying I should stop taking my meds? If psychiatry is abolished, I won’t have access to them anymore.

Psychiatry selectively restricts your access to psych medication unless you can perform a convincing enough song and dance to the relevant professionals. If you can navigate the medical system and obtain an ADHD diagnosis (which can itself be a risk), you can purchase stimulants and use them legally. If you can’t, or don’t have the time or money to access those services in the first place, or live in a place where it is not a possibility, you might turn to other stimulants, such as meth or speed, which are illegal. A psych abolition goal would be to ensure access to a safe supply to use in safe conditions on the patient’s terms, with accurate information on the potential effects of the substance, and for every substance; the figure of the psychiatrist and gatekeeper plays no role in this and is not necessary to this access whatsoever.

It is however useful to note that what is considered “helping” for a drug in this context is often a better adaptation to capitalism and its requirements. This is a neutral statement; surviving is necessary. But the help the medication is providing does not occur in a vacuum; under different circumstances, you might not want to be taking neuroleptics or might think the negative (to you) effects outweigh the positive (to you).

You said psych diagnoses don’t have a biological basis. So psych meds don’t work, if I understand correctly? They don’t do anything?

Psych medications do have an action; they are psychoactive substances. Their effects (sedative, stimulant, and others) does not, however, act on any illness as psych professionals will often say they do. Indeed we have already established that psych diagnoses are not illnesses (see part 1), and do not have a biological basis (see part 2): they are names used by the psych establishment to refer to clusters of symptoms. The terms often used to refer to medication or classes of medication (“antipsychotics”, “antidepressants”) are post-hoc marketing terms whose purpose is to present a disease-centered model (the common claim that they are like insulin for diabetes) of their effects instead of a drug-centered one. The medications grouped under the very wide antidepressant umbrella, for example, have nothing in common in their action, effects, or mode of functioning, except for the fact that they are all marketed (often, it is important to note, after the drug was already developed, tested, FDA-approved, and manufactured) as treating, specifically, the disease of depression. The term antidepressant serves to obscure this fact and present them as having some inherent action on depressive episodes. Similarly, “antipsychotics”, which do not prevent or reverse psychosis but make patients more calm and obedient, have previously been known as “major tranquilisers”, or more currently as “neuroleptics” —terms that have been phased out for fear of discouraging compliance with medication regimes. An honest description of their effects should be on a case-to-case basis – in a very simplified way, this could look like this: this drug acts on this hormone which will act as a sedative, but can cause nausea; this drug act on that hormone which can make you feel more focused, but might exacerbate heart problems. Often, drugs that were initially sold as acting specifically on (x) diagnosis are then re-marketed as acting specifically on (y) diagnosis instead – constant new findings being necessary to obtain FDA approval, or to keep pharmaceutical sales up and maintain authority about the validity of diagnoses and the exclusivity of medical knowledge (see part 2).

For a practical example, so-called “tricyclic antidepressants” were developed because chlorpromazine, an antihistamine, had already (after being used to manage surgery patients) been patented as a sedative for schizophrenics; Geigy funded research to develop a new medicine, extremely similar in structure but outside of the patent’s boundaries. The one they found (imipramine) improved the mood of 3 out of 300 schizophrenic patients during its first trial. This was enough to resell it as solving depression: it was one of the first drugs to be sold as targeting specifically something that had gone wrong in the physiology of depressed patients, instead of as simply reducing their feeling of sadness. In a context where some of the harmful effects of common anxiety medication like Valium were starting to be recognized, reconceptualizing depression as the underlying cause of anxiety and as chemically curable – here, through tricyclic antidepressants – allowed psychopharmacological sales to keep increasing.

So the problem is with meds, right? They are being overprescribed and psychiatry has fallen into the pocket of big pharma because of capitalistic interests. We aren’t supposed to live like this. We should just be talking with people we trust instead; drugs and addiction are bad.

Drugs (whether prescribed by a doctor or acquired otherwise) are always okay to use (even in quantities and ways commonly termed “addiction” or “abuse”) and always morally neutral. This is a crucial aspect of any serious politics of body autonomy (see the concept of “dignity of risk”, emerged from disability studies). The issue is with medication being forced upon people or withdrawn from them, and patients not being informed about the effects of the drug(s) they are taking. In fact the desired effects from many psych drugs (lithium for example, with sedation) are simply mild manifestations of their “toxic” or “side” effects (trouble walking, dizziness, coma). The levels at which the drug is considered toxic and the prescribed levels often have quite some overlap. In the case of psych medications, what people describe as “helping” is also often the same that a weed smoker gets from smoking weed: they want to be relaxed, they smoke, they are relaxed. None of this however means that they are curing an underlying condition, or that they were suffering from a weed imbalance that smoking corrected. Placing the issue on substances themselves, and the people who use them, instead of on the systems that use them as a means of social control leads to the same reactionary framework used for criminalization.

From a materialist perspective, it is also important to be wary of claims regarding an intrinsic human nature (modernity being presented as the culprit, with appeals to a return to tradition), and to not make blanket statements about psych medications in general (which drugs? In what dosages ? Under what circumstances?). We are not judging a specific situation but analyzing material conditions. Similarly, the idea that a discipline or a movement (feminism, gay rights, or psychiatry) was corrupted by capitalistic interests is always, at best, an incomplete framework. It often relies on nostalgic ideas about an imagined radical uniformly anticapitalist past and ignores the precise relationship between a discipline and capitalism: psych disciplines evolved to serve capitalist interests and alongside its economic development.

Are you actually saying there's no difference between my taking Prozac every morning and a heroin addict?

Of course, there is a difference. One is heavily racialized, and likely to land you in prison or expose you to structural violence; the other is manufactured with regulations that ensure a safer and more reliable supply (despite common shortages) for those with the means to access prescriptions. But those are social and political differences that have nothing to do with any inherent characteristic of the drug or its effects. The category of “hard drug” (just like the category of “gateway drug”) is a part of War on Drugs rhetoric and politics that targets drugs associated with (and implemented in) racialized and low-income neighborhoods in the USA (see claims about the supernatural and unique danger of fentanyl). As mentioned earlier, any psych abolition plan should include a program where any substance is rendered morally neutral and where people are free to access information and use in a safe context; this is, of course, not possible and will never be possible under our current capitalistic system. In the same way that (see part 4) it is incorrect to state that psychiatrized people should be treated like physically disabled people (understand: respected more), it is incorrect to state that the treatment of psychiatrized people is wrong because they are treated like criminals, despite being innocent. Prison abolition and psych abolition are linked (see part 5), and we must acknowledge that no one – and not people who have been convicted of crimes under a racist, capitalist system any more than others – should experience incarceration.

4. Disability justice

Recommended readings: Health Communism by Beatrice Adler-Bolton and Artie Vierkant, Care Work: Dreaming Disability Justice by Leah Lakshmi Piepzna-Samarasinha, and Abolition Must Include Psychiatry by Stella Akua Mensah for the Disability Visibility Project.

Yes, the treatment of mentally ill people is wrong. You wouldn’t ask someone with no legs to get up from their wheelchair and walk!

People do, very often. No matter what aspect of the treatment of able-bodied psychiatrized people you are discussing, it is guaranteed that physically disabled people, no matter to what degree they are psychiatrized themselves, will experience it as well, and more. Basing your antipsychiatry politics on the idea that being treated like people with a physical illness would mean more respect will always lead to an impasse, rhetorically and in practice. Comparisons resting on the fact that you wouldn’t treat (x) group in this way often reflect a misunderstanding of the structures in place and the daily experiences of that group, assumed to be widely accepted as an oppressed minority, whose oppression has social consequences for those who perpetuate it. Instead of asking for psychiatrized people to be treated like physically disabled people, we should be interrogating the structure of the hospital and the medical establishment and fighting for bodily autonomy for all along the lines of our various (and interconnected) struggles.

If psychiatric diagnoses aren’t “real”, then you’re saying that fibromyalgia, chronic fatigue syndrome, etc. aren’t real.

It is true that they function in similar ways and serve similar purposes. A diagnosis of fibromyalgia does not actually tell you anything about what is going on in your body or why you are experiencing this immense physical pain and fatigue. The treatment is often referred to as “symptomatic”: it helps with the symptoms you are experiencing but does nothing against the underlying issue (except sometimes in combination with other more specific diagnoses). Of course, people who say that those illnesses are “not real” often mean that those who suffer those clusters of symptoms should shut up, pull themselves up by the bootstraps and go back to physical work, since the disease is “all in their head”. So it is understandable that people’s reaction to encountering this claim is to retort to medical arguments: my pain is real, it’s not psychological! This assumes that the only two possibilities are: 1. that it is a medically recognized disease, has (at least partly) a biological cause, it is real, and you are justified in struggling or 2. that it is not a medically recognized disease, doesn’t have any biological cause, it is fake, you are making it up for attention, you are lazy, you are simply not trying enough. This is however a false dichotomy. A useful parallel is with the system of gender: the classification of humans between “biologically male” and “biologically female” is socially constructed and serves the purpose of structures of power. This classification being constructed, however, does not mean that 1. people do not have real, existing organs between their legs (chronic pain) or that 2. the effects of the gender system on people’s lives is not real, and devastating (ableism).

The distinction between physical and psychological is also an incomplete one. Assigning complaints of pain or generalized fatigue to “psychological” symptoms (for Lyme disease, for example) is commonly done by medical professionals in order to withdraw care from patients or deny access to analgesics, mainly towards populations that are already likely to be seen as weak, irrational, or malingering: people of color, women, gay and trans people, fat people, otherwise physically disabled people. If we remove the fact that a diagnosis is often necessary for insurance companies to approve treatment and for doctors to provide prescriptions, a diagnosis of fibromyalgia does not actually provide any insight into the problem, and is a convenient way for medical professionals (and research teams) to justify their not investigating further, finding treatment plans, conducting physiological research or listening to any of the patients’ complaints.

What about developmental disabilities? Are they real?

As mentioned above, the question of whether a disease is “real” or not has nothing to do with the life and struggles of those diagnosed with it and everything to do with the question of taxonomy. Some diagnoses listed in the DSM and widely considered as psych diagnoses also include some elements of neurological functioning, such as Narcolepsy or some of the so-called neurocognitive disorders in the DSM-V. Developmental disability is a very broad descriptor that can be applied to any chronic difficulties or impairments beginning early in childhood in areas like speech, mobility, general independent living skills, etc. Developmental disability includes conditions such as (for example) Down syndrome or cerebral palsy that have identified biological causes and diagnostic processes. However, the “developmental disability” descriptor is also applied to some psychiatric diagnoses, such as ADHD and autism. In these cases the descriptor functions differently, because psychiatric diagnosis is not made on the basis of any genetic test, anatomical or physiological observation, diagnostic imaging, or other biomarker; when psychiatrists talk about developmental disabilities or describe psychiatric diagnoses as such, they are not talking about conditions with known/observed biological causes. (If such causes were identified, these conditions would no longer be considered psychiatric in nature, but would be treated and diagnosed by the relevant non-psychiatric medical specialty!) Although “neurocognitive testing” may be used in the diagnosis of some psychiatric conditions, there is no universally accepted threshold or singular test that can diagnose any such conditions; results must still be interpreted and “matched” to a psychiatric diagnostic code. For example, what is marketed as ADHD testing generally aims to assess a number of discrete cognitive skills like directing attention, sustaining attention, etc.

Whether or not these tests are capable of returning accurate assessments of such discrete skills, that information is not synonymous with an assessment of whether a person has ADHD, as ADHD in the psychiatric matrix is a distinct condition and is not the only possible underlying cause for any such cognitive test results. Thus, antipsychiatry does include a critique of the psychiatric deployment of the concept of developmental disability; however, this does not mean that no such disability can ever be said to exist, or that antipsychiatry means interfering in the lives or care of developmentally disabled people.

For people who cannot make their own decisions, how can we respect autonomy as much as possible while also ensuring that they receive treatment?

Just like the question of the abolition of prisons, there are many answers to this question, some of whom we might not be able to envision within the current system. Often, this question is asked to justify measures that would have no place in a psych abolition program – forced incarceration, for example. The term “mentally incapacitated” is not neutral; minors are often considered too young or impulsive to be allowed to make decisions on their own body, for example regarding hormone replacement therapy. Any patient refusing a measure that a psych professional considers necessary can also be considered mentally incapacitated.

In other cases, however, such as people in comas, or people who struggle to communicate, a combination of solutions could include entrusting someone they know and choose with their care, consulting disabled organizations, and seeking to communicate (however the patient can understand best) the options available. This is a topic of ongoing discussion, notably among disability justice activists, and a decision that should be made on a case-to-case basis – while ensuring any decision can be revoked if the patient’s situation or perspective changes.

5. Carcerality and the psychiatric hospital

Recommended readings: Decarcerating Disability: Deinstitutionalization and Prison Abolition by Liat Ben-Moshe, The Neurodiversity Paradigm and Abolition of Psychiatric Incarceration by Kiera Lyons, this lecture by Talila L. Lewis, and Madness and Civilization: A History of Insanity in the Age of Reason by Michel Foucault.

Well, sometimes you do have to override a patient’s autonomy, for example when someone is about to commit suicide or murder. What about psychopaths/sociopaths/the criminally insane/people who are too mentally ill to function in society or too violent towards themselves others?

Just like the common cop show assertion that they would have caught the killer by now if not for those stupid paper-pushing bureaucrats, such statements do not have to be taken as neutral. They are designed to make you question whether existing protections against the police (presumption of innocence, burden of proof, the right to a lawyer, no matter how unequally they get applied in practice) are good; whether people really know what’s good for them; whether some people really deserve to be protected from violence. The idea that antipsychiatry advocates want to preserve their "ideological purity" by not forcing someone into inpatient even though it could save their life (or someone else’s) is medical propaganda designed to make you support those interventions. Despite being presented as a rational, getting-your-hands-dirty solution, it does not have to be taken at face value.

When someone says that forced psychiatric intervention, meaning medication, incarceration, or police involvement, really does help people (or has helped them when they were suicidal), the implication is that 1. disregarding patients’ voices is sometimes necessary and that 2. those interventions do help. However, who gets parsed as incapable of deciding is of course a matter of interest (see part 4). The solutions that are offered as a necessary evil in this case are also colored by bias (as we’ve seen, antipsychotics/neuroleptics don't actually solve a psychotic episode but only sedate the patient enough to make them more manageable; forced incarceration is highly likely to leave you more suicidal and to add a few obstacles to your recovery, such as losing your job, housing, landing you in a conservatorship, or others). Not only should keeping someone alive at all costs, no matter through what means and with what quality of life, not be a goal in itself – but even psychiatric studies regularly conclude that forced intervention increases the likeliness of a successful suicide attempt in the short and long term.

It is a common attitude regarding many topics that it’s ok to have beautiful ideas, but they sometimes hit the cold hard facts. We must respect trans people's pronouns, but biological sex is real; we can be nice to a schizophrenic person, but they are constitutionally different from us; we want to be respectful, but sometimes in the real world you just have to call the cops on someone. This is a false dichotomy. We are not antipsychiatry out of a desire to be morally pure and ignore the facts; we are antipsychiatry because we question those facts and the knowledge production systems that uphold them too. We question the idea that there are people who are constitutionally too far gone or too dangerous to be allowed outside. We question the idea that whatever small wins might have been achieved in individual cases through forced intervention could not have been achieved through different means that do not involve being stripped of your autonomy – or that anecdotal self-reported evidence of those wins should be a basis for a society-wide program (how many people who were spanked as children say that it made them stronger?).

Aren’t psych wards or social services a good alternative to prisons and cops?

The systems of psychiatry, emergency services, social work, and police are not isolated units that can work as alternatives to one another. In many countries, if you call an ambulance for someone who is having an overdose, they will automatically have to inform the police. Depending on the case, the police could refuse to let emergency services see the patient and only provide treatment through the police medical team. If you know your friend has attempted suicide in their apartment, the only people allowed to break down the door might be the police. It is well-known that both social workers and psych professionals are often required by law to report any patient who might be a danger to themselves or others. Psychological and psychiatric assessments are imposed on many people on welfare benefits; if they refuse to comply, their benefits are stopped. The parallels between prisons and psych wards have been expanded upon in much of psych abolition and police abolition theory and practice. Sexualized violence by doctors, psychiatrists, therapists, medical personnel, or police is also extremely unlikely to be acknowledged as such (without even talking of any consequences for the perpetrator): a cop strip-searching after an arrest or a doctor in a clinic inserting objects without information or consent are simply doing their job in the way that is required of them.

All those examples serve to illustrate that limiting your analysis of authority and carcerality to the police and to prisons (who are, to be clear, among its most violent enforcers) ignores the way that other professionals prop up the systems at play. To focus on psychiatry, the matter at hand, it is as much part of the carceral apparatus as the police system – which has nothing to do with individual choices or specific mentalities, and everything to do with the repression of deviance and the imposition of norms. This is important to keep in mind when conducting structural analysis and fighting back – but also when engaging with these services in the first place: you must be aware of the risks and the specific legal (and extralegal) possibilities in your area and your situation instead of considering them an inherently safer alternative to police involvement.

Under this plan, any CBO (Community Based Organization) operating in the city’s racial and ethnic neighborhoods could be transformed into a portal for the county’s mental health system by placing a race-based community mental health worker in it. By 1971, the NIMH (National Institute of Mental Health) decided to replicate the county’s strategy by creating two separate task forces for Spanish-speaking and Asian American populations in order to transform Latin and Asian American CBOs into de facto CMHCs (Community Mental Health Center) across the nation. As Cannon explained, CMHC and Pathologizing the Crisis: Psychiatry, Policing, and Racial Liberalism in the Long Community Mental Health MovementCBO staff provided a way for providers to “reach the young and the old who need help but just won’t come to a mental health center” because of the associated stigma. 61 More importantly, such services infused the racial and ethnic pride movements in other neighborhoods of color with the same community norms of middle-class respectable marriage and family advocated by federal urban policy.

Pathologizing the Crisis: Psychiatry, Policing, and Racial Liberalism in the Long Community Mental Health Movement, Nick John Ramos

What about (x) alternative to psychiatry? What about work therapy or occupational programs?

In general, the answer to that question (including private or semi-private clinics with a focus on patient autonomy, yoga, meditation, or others) depends less on whether the alternative “works” and more about the dynamics of power. If you are seeking treatment there, are you free to leave at any time? Do the staff have authority over you, will you be believed and supported if you oppose them? Is any police involvement possible – or even required?

Many antipsychiatry theorists were working within the psych system and designed alternatives to mainstream psychiatry, such as the La Borde clinic or the Saint-Alban hospital in France or Kingsley Hall in the United Kingdom. The limits of such initiatives are clear according to what has already been discussed: neuroleptics were prescribed and ECT practiced at La Borde; despite claims to the contrary, the word of a patient and of a nurse did not have the same weight; the ultimate goal was still to enforce adherence to social norms. In any case, a limited number of inadequate alternatives would not have constituted a viable antipsychiatry program, since the people able to enter those programs were often those with race or class privileges, inaccessible to the vast majority of psychiatrized people.

Similarly, talk therapy (with no medication) is often presented as a healthier, less violent alternative to psychiatry; this allows therapists to avoid criticism leveraged towards the medical system, since they do not prescribe drugs and mostly do not have a medical license. However, talk therapy still forms part of the psychiatric apparatus and serves the same social and political purposes. In the same way, not explicitly diagnosing or assigning labels to patients does not in any way make psychiatry any less oppressive. This is where the terminology we use matters: though the term “antipsychiatry” limits its criticism to psychiatry, other alternatives, like “psych abolition”, successfully integrate other domains that are not strictly speaking medical, like therapy, in their criticism, as parallel but no less damaging technologies of social control.

Regarding occupational therapy, it rests on an idea of work as inherently redemptive (and as leisure as inherently suspect, likely to have caused psychiatric problems in the first place), underlining the goal of psychiatric treatment to reintegrate its patients into a productive, capitalistic existence. This does not even take into account the more obvious cases of exploitation (just like for prisoners, work performed by patients in mental hospitals is often not or very little remunerated and performed in highly unsafe conditions, with no possibility to unionize or negotiate). Studies reporting on the effectiveness of occupational therapy are, again, often led with a specific perspective of what “recovery” or “proper functioning” looks like.

6. Normality, neurotypicality and capitalism

Recommended readings: The Myth of Mental Health by Kai Cheng Thom and Psychiatric Hegemony: A Marxist Theory of Mental Illness by Bruce M. Z. Cohen.

I know I experience things differently from other people. I know I struggle more than other people. I know I don't relate to other people, and others can tell, I've been bullied and abused for it my whole life. This means I operate differently from neurotypicals.

This is a difficult one to answer due to how common this statement is – and how strong the knee-jerk reaction it generates in people, for understandable reasons. We’ve already established that the idea of having a “different brain chemistry” is inaccurate. Think about the people around you: how many people will never, in their life, experience episodes of intense grief, terrible depression, nerve-wracking anxiety? You might say that what differentiates a neurotypical from a neurodivergent person is the regularity and intensity of these symptoms. But how can it be measured? What would be a 5 on someone’s depression scale will be a 10 for someone else. Does that mean one of them is lying? As opposed to observable illnesses, there is no objective phenomenon that could render someone neurotypical. Who is the neurotypical? Someone who has not failed enough at the system to be medicalized because of it – yet. It is an ideal that people are expected to live up to within capitalism.

Some parallels are possible with the category of able-bodied (which some people refer to as temporarily able-bodied, to emphasize the eventual likeliness of disabling accidents and illnesses for everyone), since the state of being able-bodied does not refer to a specific biological truth, or bodily arrangement, but rather to your ability to fulfill expectations. However, it is possible for someone to experience no recurring pain, incapacitating illness, or inability to perform expected physical functions, for a significant part of their life.

None of this means that there are no material differences between a person whose anxiety does not prevent them from having socially expected relationships and holding down a job and housing, and a schizophrenic person who has spent most of their life incarcerated in a mental hospital and is considered incapable of making any decision on their own. What it means is that the framework of the neurotypical is not accurate to describe the difference between their lives: it leads to constant discussions on what constitutes a neurotypical (or absurd debates regarding privilege: how many trans people can be truly considered “neurotypical”?) and who fits or not within the category. If you experience social anxiety to the point that leaving your house is difficult, but that you are able to hold down a remote job – does that mean that you are neurotypical compared to someone who cannot and has never performed salaried work? What level of difficulty in leaving the house would be enough to classify you as not neurotypical? Who are the “other people” implied in saying that you don’t function like others do, what do they look like, how do they function, and can you ever confidently say that you have met them? If someone functions according to social expectations their whole life but sinks into depression as 40, does that mean they were neurotypical before but no longer are?

It must be possible to discuss the advantages conferred by your level of ability to function within capitalistic society (which nuances are often obscured by sorting people only into “neurotypical” and “neurodivergent”), and to discuss the social expectations implied in the category of “neurotypical”, without confirming psychiatric diagnoses as revealing an inherent, unchangeable truth about people or their brain.

The problem is Western psychiatry: it doesn’t take into account cultural differences and is only tailored to people in the West.

Colonialism, imperialism, and psychiatry are inherently linked and developed alongside each other, with, for example, psychiatry justifying colonial expansion and European supremacy during the 19^th century or colonialism providing subjects for medical experimentation in order to develop psychiatric knowledge. It is, however, incorrect to place an arbitrary separation between Western and non-Western psychiatry. It has been clear throughout this document that psychiatric theories (Jungian archetypes, for example, or biopsychiatric assertions) are not true for people within the imperial core, for which they were developed, anymore than they are for people in the periphery. Furthermore, psychiatry plays an oppressive role in the Global South as well, with psychiatrized people in their national context leading resistance against those systems in every place in the world.

In great part due to colonialism, the various psychiatric systems in the world are not isolated from each other: France, for example, set up clinics in colonial Algeria that attempted to justify the inherent racism in the French colonial mission on the basis of a theorized racial inferiority. Some of these clinics still exist today, using many of the same frameworks and resources. Finally, placing the issue on Western psychiatry is often a way for authors to justify their unwillingness to interrogate what they consider exclusive to Western psychiatry in the first place, or by the West as a concept.

Well, capitalism exacerbates my symptoms, but I would still be depressed/autistic/anxious/ psychotic in a non-capitalist society. The way my brain works would still cause suffering, and shouldn't this suffering warrant description?

It’s true that capitalism does not create the symptoms it pathologizes – or at least, does not create all of them. What it creates is the illness under which this pathologization happens. Many of the sources of psychiatrized people’s struggle in the current day are linked to the systems under which we live: not being able to escape from your abuser as a child due to the structure of the family, seeing family or community members be repeatedly sent to prison or assassinated due to the racist carceral system, living for years in and out of homelessness due to capitalism.

The idea, however, that we can maintain psych diagnoses as categories without maintaining the oppressive structure of psychiatry, is equivalent to wanting to maintain gender without maintaining gender roles. Some of the symptoms that are currently grouped under the umbrella of psych diagnoses, granted, are (at least in part) neurologically instantiated. No serious antipsychiatry politics would state that no one outside of capitalism would experience hallucinations, or a deep, nerve-wracking fear with no clear cause, or would find certain textures and sounds completely unbearable. What is specific to psychiatry, however, is that those characteristics, instead of being treated as variations within the human experience, are considered illnesses which must be solved instead of providing accommodations within the parameters of what the person wants. It is also true that we do not need to have all the answers regarding how to accommodate various modes of functioning in an ideal society in order to recognize that the current system is violent and untenable and that diagnoses do nothing to help those who suffer the most from it.

OK, you say psychiatry needs to be abolished. How can I feel better, right now? How can I address these problems, right now? How can I help my friend who wants to kill themselves, right now? What is the actual plan?

This question is at the heart of psych abolition, but also of prison abolition, gender abolition, and other politics of liberation. First, as mentioned earlier, it is in no way a contradiction to hold antipsychiatry politics and to access psychiatric services such as drugs or therapy, as long as you are aware of the risks and possible effects of different aspects of treatment. Though this document remained quite general, it is important to research the psychiatric laws specific to your own country and your own situation, as those laws (and the punishment they can engender) vary massively. It is useful to know drug laws and mandatory reporting laws in your area for yourself and for others.

As a communist, the actual plan entails the end of the dictatorship of the bourgeoisie. In the meanwhile, however, there are several options you can pursue if you wish to get organized for psych abolition. Harm reduction initiatives, needle exchange programs, sex worker groups, and drug user unions exist in many countries; groups for survivors of psychiatric violence are also common; many organizations fight and lobby to outlaw some specific psychiatric practices, such as ECT or involuntary commitment. Forming strong mutual aid networks is crucial to help offer treatment alternatives that are not locked behind engagement with psychiatry. I would however note that a treatment being “community-based” does not necessarily mean that it is free of carceral logic, other reactionary frameworks, or even that it does not involve psychiatric services.

The most useful tools to help with feelings of suicidality or to find help for substance abuse were all written by psych survivors themselves. Many blogs, channels, and social media accounts exist that discuss those issues from a psychiatrized perspective. As always, keep a critical mind (especially when the content comes from psych professionals themselves), and pick and choose the resources you find the most useful for your particular situation.

Bibliography

Titles in bold indicate the readings I consider the most foundational and the most accessible.

Articles

• Abolition Must Include Psychiatry by Stella Akua Mensah for the Disability Visibility Project

• Context, Clarity and Grounding for Stolen Bodies, Criminalized Minds & Diagnosed Dissent: The Racist, Classist, Ableist Trappings Of The Prison Industrial Complex by Talila L. Lewis

• “My Doctor is Lacking Insight”: Alternative Experiences of Insight in Mental Health on Psychiatry is Driving Me Mad

• Pathologizing the Crisis: Psychiatry, Policing, and Racial Liberalism in the Long Community Mental Health Movement by Nick John Ramos

• The Myth of Mental Health by Kai Cheng Thom

• The Neurodiversity Paradigm and Abolition of Psychiatric Incarceration by Kiera Lyons

Books

• Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

• Care Work: Dreaming Disability Justice by Leah Lakshmi Piepzna-Samarasinha

• Decarcerating Disability: Deinstitutionalization and Prison Abolition by Liat Ben-Moshe

• Health Communism by Beatrice Adler-Bolton and Artie Vierkant

• Madness and Civilization: A History of Insanity in the Age of Reason by Michel Foucault

• Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness by Anne Harrington

• Psychiatric Hegemony: A Marxist Theory of Mental Illness by Bruce M. Z. Cohen

• The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment by Joanna Moncrieff

Videos

• Myth of the chemical imbalance by CEP UK

• No known biological causes by CEP UK