Prof Peter Beresford Introduces Studies in Mad Matters
On Thursday 24 October 2013 at 7.00pm Peter Beresford introduced Mad Matters at the 17th Edinburgh Independent Radical Book Fair. This is a podcast of his talk:
Prof Peter Beresford, a long term mental health service user and survivor, introduces Mad Matters which offers a twenty-first-century view of madness and distress, and discusses how we can move from stigma to first hand experience to develop new social understandings and challenge our emotional difficulties and distress in a maddening world. He is the author of many publications on social and community care and inclusion.
The book his is introducing (Mad Matters) is a reality check. Bringing together a collection of critiques on psychiatric practices which occur to the individual as negative and destructive. It is a resource for reforming perspectives and important for people who suffer from the psychiatric world as much as for all professionals working in ‘mental health’.
The issues covered in the book can be applied anywhere in the world where the bio-medical model is the dominant paradigm. This marks the emerging of a field of social and ethical study championed and pioneered by many, but here it is a demonstration of the strong critical psychiatry movement in Canada. As a culture which has pioneered emancipation of this discourse, Canada also delivered the first degree course on ‘Mad Studies’ which takes the perspective of the person receiving the attentions of the clinician rather than the clinician itself.
Dedication of the Book
The book ‘Mad matters: a critical reader in Canadian mad studies’ is a collection of writings brought together by the editors Brenda A. LeFrançois, Robert Menzies, and Geoffrey Reaume. What is fitting here is to share the dedications of this book which they have made to help personalise the reader to the connections which exist between the academic content and the lives of people.
There is a necessary correction to be made in the institutional setting which has been greatly depersonalised over generations. This kind of depersonalisation, arguably, shoulders a significant amount of responsibility of the travesties that have been committed upon people in the settings of institutions – a theme which Mad Studies examines amongst others.
Brenda A. LeFrançois:
To my two strong and intelligent daughters, Juliette and Adèle, that you may continue to grow in your understanding of the importance of social justice, including both the activism and scholarship that are necessary to meet those ends. To my partner in life, Jean-Marc Bélanger, whose embodied kindness and wisdom envelops me and sustains me. To the memory of Professor David Brandon (1941–2001) whose mad academic mentoring continues to inspire me long after his passing.
To my partner in all things, Dr. Dorothy E. Chunn, with love, gratitude, and admiration. To the memory of my teacher, Dr. Richard V. Ericson (1948–2007), in appreciation of the remarkable legacy of critical scholarship that he handed down.
For my beloved wife, Esther Jeeyoon Lee, who lives what she studies. In memory of Ron Wilson (1937–2005) for his friendship and “amazing grace.”
It seems fitting also to include here the acknowledgments which are found in the textbook seeing as in great part this emergent field of academic study is about acknowledging the experience, voices and existence of generations of people who have suffered psychiatric marginalisation in various cultural contexts.
The act of acknowledging someone is an evolutionary act which moves the discourse and arguments from the ground of present status quo to new territory that renegotiates the power relations. Prof Susan Fiske is Professor of Psychology and Public Affairs at Princeton University is well known for her work on social cognition, stereotypes, and prejudice. In her book ‘Envy Up, Scorn Down: How Status Divides Us’ she explores how silence and a failure to acknowledge individuals represents a form of scorn and falls into the psychology of dehumanization:
“Another reason psychologists do not study scorn is that it is often a matter of neglecting and ignoring someone. ‘Silence is the most perfect expression of scorn,’ claimed George Bernard Shaw, who would know. Scorn is the absence of respect, a lack of attention, a failure to consider. A failure to acknowledge another person provides evidence of scorn.
In a famous story entitled ‘Silver Blaze,’ Sherlock Holmes solves a case that hinges on ‘the curious incident of the dog in the night-time’: when a watchdog fails to bark at an intruder, Holmes deduces that the criminal must be the dog’s owner. In a variant on this absence-as-evidence, not only would a scornful dog not bark in alarm, but a scornful dog also would not even wag its tail in recognition. Scorn is known by what it fails to do.
Political systems can create scorn: ‘The centrality of hierarchy suggests a link between contempt and indifference. The underling is pathetically weak, so contempt can take the form of dismissing him,’ according to the political theorist Don Herzog. John Adams, always acutely attuned to (dis)respect, describes the shame of the poor man, who is neglected and despised. He feels himself out of the sight of others, groping in the dark. Mankind take [sic] no notice of him. He rambles and wanders unheeded. In the midst of a crowd…he is not disapproved, censured, or reproached; he is only not seen.”
-Fiske, S. T. (2012). Envy Up, Scorn Down: How Status Divides Us. 8%
Mad Studies represents the emergence of a field of academia where people who have been relegated to silence, to non-acknowledgement are starting to be recognized as having something valuable and important to understand. Psychiatric labels are all too often reasons to dismiss and ignore the experience and knowledge someone has.
The following people and organizations have contributed in a wealth of amazing and vital ways to the making of this book:
The talented and critically engaged community of contributors to the 2008 Madness, Citizenship and Social Justice Conference, Simon Fraser University, which set the stage for this project. Worthy of special mention are Anne-Marie Feenberg and Trish Graham, former Director and Program Assistant, respectively, for the SFU Institute for the Humanities; the Institute’s J.S. Woodsworth Resident Scholar program and Endowment Committee (chaired by Samir Gandesha), along with its Social Justice and Citizenship working group (Adrienne Burk, Dorothy Chunn, Margaret Jackson, David Mirhady, and Bob Russell); the Social Sciences and Humanities Research Council of Canada; and the SFU offices of the President, V/P Academic, and Dean of Arts and Social Sciences.
Our ever-inspiring colleagues and students in the School of Social Work, Memorial University of Newfoundland; the Department of Sociology and Anthropology, Simon Fraser University; and the Graduate Program in Critical Disability Studies, York University.
Sobia Shaikh for providing detailed feedback, and the members of the Critical Race Theory and Anti-Colonial Theory Discussion Group at Memorial University who read and commented on an earlier version of some of the chapters.
Our friends and supporters at Canadian Scholars’ Press, who have embraced this project from the outset with enthusiasm and clarity of vision: Andrew Wayne (President), James MacNevin (Acquisitions Editor), Daniella Balabuk (Developmental Editor/Permissions Coordinator), Caley Baker (Production Editor), and Rhoda Dinardo (Copy Editor).
The four external reviewers for CSPI: Nancy Hansen, Interdisciplinary Master’s Program in Disability Studies, University of Manitoba; Tom Brown, History, Mount Royal College; Gregor Wolbring, Community Health Sciences, University of Calgary; and Joanne Woiak, Disability Studies, University of Washington.
Peter Beresford, Brunel University, whose eloquent and generous words grace the Foreword to this collection.
Leef Evans of Gallery Gachet for contributing the evocative cover image, and Lara Fitzgerald, Gallery Gachet’s Programming Director, for making this happen.
Irit Shimrat, who expertly compiled the index; and the chair and members of the SFU University Publications Funds committee, who provided the funding for it.
The extraordinary cast of contributors to Mad Matters, every one of whom has advanced the causes of Mad Studies and social justice in powerful ways through words, images, and deeds.
With the kind facilitation of CSPI, we are directing royalties earned by book sales to Our Voice/Notre Voix of Moncton, the Psychiatric Survivor Archives of Toronto, and Gallery Gachet of Vancouver.
This article is a study document as a part of the Mad World archive. For the purposes of review, public study and promotion of this textbook the introduction to the subject field is reproduced here. This excerpt from the book is available as an open access paper to download from the author’s website for free:
Introducing Mad studies
Robert Menzies, Brenda A. LeFrançois, and Geoffrey Reaume
“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.
“You must be,” said the Cat, “or you wouldn’t have come here.”
—Lewis Carroll, Alice’s Adventures in Wonderland
The madness about which I’m writing is the madness that is more or less present in each one of us and not only the madness that gets the psychiatric baptism by diagnosis of “schizophrenia” or some other label invented by the specialized psycho-police agents of final phase capitalist society.
—David Cooper, The Language of Madness (1978)
As for the term, Mad Studies, it has emerged from a collective assemblage of enunciation, from a multitude of voices. Like Nietzsche, through whom some of those voices spoke, it is a destiny.
—Richard Ingram, Personal Communication (2011b)
Mad matters, and so does the study of madness and psychiatrization, and so too does Mad Studies.1 The matter of Mad Studies—and that Mad does matter—is the express purpose of this reader; we explore here the various ways to take up the matters of “psychiatrization,” “madness,” the oppression and agency of Mad subjects, and the battle against psychiatry and psychiatric discourse as a way to introduce Mad Studies as an emergent field of study that matters.
This is not to suggest that the matters covered in this reader are wholly new. On the contrary, many of these matters have been raised conceptually, and through actions of resistance within activist circles, within the academy and amongst radical practitioners since the very beginning of organized psychiatry in Canada and abroad.
However, this reader represents the first text to consolidate Mad matters within a Canadian context, which we have done under the new umbrella of “Mad Studies.” It also combines the more established understandings of Mad matters, including antipsychiatry approaches and long-standing psychiatric survivor narratives, with an exciting and burgeoning form of activism and conceptualizations, emanating from a new generation of people in Canada engaging in a variety of forms of radical and Mad activist scholarship.
In 1981, Toronto activist-survivor Mel Starkman wrote: “An important new movement is sweeping through the Western world.… The ‘mad,’ the oppressed, the ex-inmates of society’s asylums are coming together and speaking for themselves. The map of the world is dotted with newly formed groups, struggling to identify themselves, define their struggle, and decide whether the ‘system’ is reformable or whether they need to create an alternative community” (Starkman, 1981; see Chapter 1).
As Starkman proclaimed in 1981, so too this book proclaims over 30 years later the radical reclaiming of psychic spaces of resistance against the psychiatric domination of Mad people as a collection of chemical imbalances needing to be corrected in a capitalist system that prizes bourgeois conformity and medical model “fixes” above all. This book, in contrast, prizes the decades-long resistance of activists and allies in Canada who have sought to provide an alternative to Big Pharma and profiteers in the psychiatric system and academy who make a living labelling and medicating that which they cannot imagine or tolerate.
Mad Matters therefore is part of a wider current that is helping to promote “Mad Studies” inside and outside post-secondary institutions. It is also intended to tap into the desire for “an alternative community” that Starkman wrote about, where people can get a sense of who they are and what madness is about without being automatically pathologized with a mental disease as happens in so many other spaces.
Mad Studies in this sense incorporates all that is critical of psychiatry from a radical socially progressive foundation in which the medical model is dispensed with as biologically reductionist whilst alternative forms of helping people experiencing mental anguish are based on humanitarian, holistic perspectives where people are not reduced to symptoms but understood within the social and economic context of the society in which they live.
As such, antipsychiatry is included within Mad Studies as contributing much to our understanding of the nature of psychiatric thought and practice by helping to reveal the inner workings of a profession that has dominated interpretations of madness but which, over the past 50 years, has had critics from within and without assail its presumptions, criticisms which continue today.
In this respect, we are not locating “Mad Studies” as originating solely within the community of people deemed Mad, but also as including allies, social critics, revolutionary theorists, and radical professionals who have sought to distance themselves from the essentializing biological determinism of psychiatry whilst respecting, valuing, and privileging the Mad thoughts of those whom conventional psychiatry would condemn to a jumble of diagnostic prognostications based on subjective opinions masquerading as science.
Moreover, the field of Mad Studies is relevant to a range of interconnecting social movements as well as a range of academic disciplines. These areas of thought and action circulate through this collection, precisely because of its interdisciplinary nature, its wide yet focused scope, and its importance in Canadian social policy as well as the activist community. This reader represents a collection of chapters in a growing field with interconnections across a host of disciplines and reaching out into the activist community in Canada and internationally.
The importance for all forms of activism must be underscored; that is, Mad Studies is vital in informing Mad politics as well as anti-poverty organizing, queer politics, race politics, anti-colonial resistance, diaspora, and the various human rights movements, such as women’s rights, children’s rights, disability rights, and trans rights, among others.
Furthermore, Mad Studies is reaping the benefits of its new and ongoing partnerships with other marginalized groups. In learning from our intersecting experiences of both oppression and resistance, through our identification with groups whose organized existence also threatens current forms of social dominance (LeFrançois, 2012), Mad politics can only strengthen its abilities in challenging psychiatry whilst also supporting wider resistance struggles.
The inspiration for this book comes from our encounters with the rich and innovative body of critical writing on madness, human rights, and the “psy sciences” that has been flourishing in this country over recent years. Across a range of institutional and cultural contexts, activists, psychiatric survivors, academics, journalists, and dissenting practitioners have been challenging the conventional biological paradigm of “mental illness”; exposing the systemic and symbolic violence that lie at the core of the psychiatric system; constructing radically creative ways of thinking about matters of the mind; linking the struggle against biopsychiatry with other movements organized around gender, race, disability, social class, culture, and generation; building a critical community that now spans all regions of the country; and practising mental “difference” and recovery as liberating ways of expressing our humanity and engaging in political debate and practice.
In this book, we showcase an original collection of work that has emerged from these exciting trajectories of engagement, and we represent Canadian critical Mad Studies as an emerging, and increasingly vital, field of study and activism.
The contemporary Mad movement came into being during the decades of the 1960s and 1970s, an especially turbulent period in the history of the psy sciences, and in the ever-shifting relations between psychiatry, society, the individual, and the state. The post-WWII years had ushered in a powerful new wave of therapeutic discourse and practice in advanced liberal democracies worldwide.
The mental health industry had undergone a quite spectacular rebirth, successfully asserting its domain over ever-widening spheres of public and private life in what Robert Castel and his colleagues would later describe as the “psychiatric society” (Castel, Castel & Lovell, 1982). Buoyed by an arsenal of new biogenetic theories and somatic technologies (among them, the first generation of so-called “antipsychotic” neuroleptics, and brain-scanning devices such as x-ray computed tomography) (Schrag, 1978), and liberated from its longestablished institutional confines by a wholesale collapse of the asylum system amid the “community mental health movement” (see Shimrat, Chapter 10), psychiatry was in the process of flexing its disciplinary muscles as never before.
From its first release in 1952, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) was already well en route to becoming North America’s prime mental classification system—the go-to definer of mental pathology that it is today (Caplan, 1996; Kutchins & Kirk, 1997). If in the 1970s we had yet to become a Prozac or Ritalin Nation, Valium, Librium, and the tricyclics were flooding our marketplaces and synapses as epidemics of “depression” and “anxiety” were ominously declared (Greenberg, 2010; Lane, 2007) and prescriptions flew off physicians’ pads by the millions. From our private thoughts to our love lives to the workplace to the world of entertainment and consumption, it seemed that no sphere of late 20th-century life fell beyond the mandate of mental medicine to refashion self and civilization, and to make us all happy, actualized, docile, and safe.
Yet the movement to psychiatrize contemporary culture never went unopposed. Through the 1970s and the decade that preceded it, scholars, activists, and people who would later self-identify as survivors of the mental health system began to mobilize against the advancing powers of psychiatry along a number of divergent (and often mutually colliding) fronts. As chronicled by Ingleby (1980), Pearson (1975), Sedgwick (1982), Ussher (1992), and many more, the psychopolitics of that era were volatile and complex.
To be sure, common themes galvanized the antipsychiatry movement in its championing of human rights for psychiatrized citizens, and in its opposition to the burgeoning therapeutic state and the medicalization of everyday life; from arbitrary, exclusionary, racist, homophobic, gender-biased diagnostic codes and interventions; to involuntary mental confinement and enforced “treatment”; to electroshock, Big Pharma, and the profusion of chemical straightjackets branded as therapy; and, increasingly, to systemic deinstitutionalization and the wholesale urban ghettoizing of ex-patients under the transparent deceit of “downsizing” and “reintegration.”
At the same time, the sheer diversity of those people and organizations aligned against institutional psychiatry was nothing short of breathtaking. In the United States, from within the ranks of the discipline Thomas Szasz had launched his lifelong campaign against what he termed the “myth of mental illness” (1961), condemning his profession for its arrogance and coercive methods, and advancing a libertarian model of mental health care in which patients and service providers would be contractual equals and the latter would be stripped of the power to compulsorily impose social control in the name of “treatment.”
Scarcely less influential had been journalist Albert Deutsch’s lacerating exposé of the concentration camp-like conditions of mental hospitals in The Shame of the States (1948), followed through the next two decades by Erving Goffman’s celebrated ethnography of St. Elizabeth’s Hospital as “total institution” in Asylums (1961); by Ken Kesey’s iconic novel One Flew Over the Cuckoo’s Nest (1962), later famously adapted to film by Milos Forman (1975); by Frederick Wiseman’s devastating (and, for a quarter-century, shamefully banned) documentary Titicut Follies (1967) on the unqualified hell that was the Bridgewater institution in Massachusetts; and by David Rosenhan’s subversive study of eight pseudo-patients who found their mental status under siege while being “sane in insane places” (1973).
On the other side of the Atlantic, radical psychiatrists like R.D. Laing (1960, 1967), David Cooper (1967), and Franco Basaglia (Scheper-Hughes & Lovell, 1987) were at the leading edge of a transnational antipsychiatry school committed to Laing’s “politics of experience,” the challenging premise that madness could only be understood and engaged existentially and through the eyes of those who lived it. For the European anti-psychiatrists, the objectification of so-called “mentally ill” people under the guise of science was a deeply dehumanizing pursuit that required challenging through a wholesale rethinking of human consciousness and being.
Whether psychosis was, or is, an exploration of selfhood or a journey to self-actualization may remain a contested idea. But there is no doubting the impact of Laing’s experiments with the therapeutic community at Kingsley Hall (Barnes & Berke, 1971), and Loren Mosher’s groundbreaking Soteria Project (Mosher, 1995), and the revolutionary shift in Italian mental health policy, spearheaded by Franco Basaglia, towards patientcentred, humane, local modes of intervention (Donnelly, 1992).
Then there was Michel Foucault, whose Madness and Civilization (1965), an iconoclastic chronicle of sanity’s war on madness as the triumph of reason in the age of Enlightenment, was being read in abridged translation throughout the English-speaking world (the complete original version was only published in English in 2006 as History of Madness).
Simultaneously, and arguably for the first time in a systematic way, people bearing psychiatric diagnoses both within and beyond institutional settings were commencing to organize through grassroots democratic action into what was initially referred to as “mental patients’ liberation,” and later as the “c/s/x” (consumer/survivor/ex-patient) movement (in North America) and the “psychiatric survivor” or “service user” movement (in the United Kingdom). English-language epicentres included London, Berkeley, Boston, New York, Toronto, and Vancouver where the Mental Patients Association (MPA) evolved into a major force for human rights causes, housing and social support, and progressive democratic action of various kinds through the 1970s (Beckman & Davies, Chapter 3; Chamberlin, 1978; Shimrat, 1997).
Finally, secondwave feminism embraced the aims of antipsychiatry at multiple levels. Phyllis Chesler’s Women and Madness (1972) was perhaps the most influential book of this period, advancing the thesis that women were held to different and higher standards of reason and normalcy than were men, that the psychiatrization process was profoundly genderbiased in its premises and effects, and that the very constitution of sanity and “mental illness” in late 20th-century society was anchored in the bedrock of male normativity.
Fast on the heels of Chesler’s book came Women Look at Psychiatry (1975), edited by Dorothy Smith and Sara David, which offered an experiential, women-focused interpretation of the malestream psychiatric system through the eyes of those who had encountered, and been damaged by, it. Moreover, a wider critique of medical power and practice was flourishing, inspired in part by Ivan Illich’s groundbreaking writings on “medical nemesis,” the “expropriation of health,” and the corrosive impact of the “disabling professions” (Illich, 1976; Illich et al., 2005). If the 1960s and 1970s were a golden age of antipsychiatry and Mad liberation, the following two decades witnessed powerful currents of backlash and retrenchment.
The sulfurous odour of counter-revolution was in the air as biogenetic psychiatry re-established its dominion in reaction to the activist breath of fresh air that was soon to be either suffocated or co-opted, depending on circumstance and usefulness to the medical model establishment of “new ideas.” Thus new diagnostic systems increasingly sought to pathologize everyday behaviour in ways that reflected both the intellectual and moral corruption of participating medical professionals and academics who allied themselves with corporate drug pushers to form the most nefarious influence on the lives of millions of people categorized as “mentally ill” the world has ever seen—and all from a Western, American-centric, culturally narrowminded perspective (Caplan, 1995; Healy, 2008; Watters, 2010)
In the midst of the growth of this medical monstrosity, where pills were promoted as the ultimate panacea (Whitaker, 2002, 2010), legal rights won in the activist heydays of the 1970s and early 1980s were gradually rolled back and new laws introduced to curtail rights even further gained traction (see Costa, Chapter 14; Fabris, 2011), electroshock rose from the ashes of denunciation to become “respectable” again (see Weitz, Chapter 11), and deinstitutionalization was increasingly decried as at fault for social inequities experienced by psychiatric survivors in the community, rather than long-standing systemic prejudices that led to chronic underfunding of social supports that were supposed to go along with the release of ex-patients from institutions.
With the extension of diagnoses within revised versions of the DSM and ICD,2 we also witnessed the widespread diagnostic labelling of children with a variety of psychiatric disorders, which are so clearly connected to controlling their thoughts and behaviour (LeFrançois, 2007), within schools, at home, and within state-run foster/residential care.
For example, children who were once thought of as behaving badly have been increasingly diagnosed with conduct disorders; children—including toddlers—once seen as having vivid and creative imaginations have been increasingly diagnosed with psychotic disorders; and children who were once understood as expressing sadness or low moods have been increasingly diagnosed with depressive disorders, whilst high energy, “uncontrollable” children have been increasingly diagnosed with a range of hyperactivity-related disorders.3
Perhaps most disturbingly,children who have survived child abuse and other forms of trauma, including statesanctioned and politically motivated violence (Rabaia et al., 2010), have been increasingly diagnosed with a wide range of “mental illnesses,” including many different permutations of those mentioned above, and have been given a cocktail of drugs to presumably match each diagnosis.4
Paradoxically, during these decades of increased psychiatrization of children, we also witnessed the rise of the children’s rights movement. This movement, and the enactment of international legislation to support the human rights of children, brought with it a proliferation of organizations run by and for children, most notably amongst politicized groups of physically disabled children and children in state care,5 who have organized around and lobbied against the inherent adultism within society generally and within children’s services specifically.
However, absent from the children’s rights movement, internationally, has been collective resistance in the form of politicized children’s organizations formed by psychiatrized children (LeFrançois, 2010). Instead, adults, including children’s rights advocates, academics, and radical practitioners, have taken up the issue of the widespread psychiatric violence committed against children (Breggin, 2001, 2002; Breggin & Breggin, 1998; Coppock, 1997, 2002; Laws et al., 1999; LeFrançois, 2007; Spandler, 1996).
Dovetailing from the trend, provoked by the children’s rights movement, to include children as full participants in—rather than the objects of— research studies, researchers began to document children’s own narratives—with limited or no adult interpretations—regarding their experiences of distress and psychiatrization (Farnfield, 1995; LeFrançois, 2007; Spandler, 1996). Ethics review boards (not) permitting, this led to calls to engage with psychiatrized children as co-researchers within (community-based) participatory research projects (Laws et al., 1999; LeFrançois, 2006; Liegghio, forthcoming).
With the acknowledgment of the agency of all children, including psychiatrized children, and fighting the tendency for adults to advocate for them and interpret their experiences from an (unavoidably) adultist perspective,6 psychiatrized children began to demonstrate their resistance and self-advocacy in the form of writing their autobiographical stories of oppression at the hands of psychiatry (see, for example, Michener, 1998).
In other spheres as well, and at times seeming to defy all odds, the voices of dissent against the resurgent biopsychiatric industry and its confederates in Big Pharma have never been stronger. Through the latter decades of the 20th century, and into the present day, critical scholarship and activism have flourished around the world as never before.
Without downplaying the very real differences in identities, political values, and forms of expression that mark (and sometimes set apart) the many strands of antipsychiatry, critical psychiatry, mental patients’ liberation, psychiatric survivor activism, and Mad pride, local and global mobilizations for psychiatric citizenship and social justice in mental health have evolved into a dynamic social movement that is unquestionably here to stay.
Along with these developments, a remarkable body of academic and popular writing has accumulated that forcefully refutes the dubious claims of biopsychiatry to scientific status and benevolent design—contesting, by turn,its self-referential historical narratives, its pseudo theoretical foundations of ideas, its arbitrary nosological systems, its barren and often calamitous regimes of “treatment,” and the coercive policies, structures, and practices psychiatry has devised in advancing its reach into ever-expanding fields of modern life.
For their part, Canadians have figured prominently in the production of critical knowledge in opposition to psychiatric authority and human rights abuses, contributing both historical and contemporary critiques of the psy disciplines and narratives of those who encounter it as subjects and adversaries (Burstow, 2003, 2005, 2006a,b; Burstow & Weitz, 1988; Cellard & Thifault, 2007; Chan, Chunn & Menzies, 2005; Church, 1993, 2006; Cohen, 1990; Davies, 1989; Everett, 2000; Fabris, 2011; Grenier, 1999; Kendall, 2005, 2009; Kilty, 2008; LeBlanc & St-Amand, 2008; LeFrançois, 2006, 2008; McCubbin, 1998, 2003; Menzies, 1989, 2001, 2002; Morrow, 2003, 2005; Perreault, 2009; Poole, 2011; Ralph, 1983; Reaume, 2000, 2002, 2006; Shimrat, 1997; St-Amand, 1988; Teghtsoonian, 2008; Vogt, 2011; Voronka, 2008a,b; White, 2007, 2009).
Moreover, just as psychiatry has globalized its operations in this era of transnational communication, marketing and commerce, so too has the Mad movement been sharpening its tools for conviviality (Illich, 1973) and expanding its frontiers around the planet. With vibrant centres of engagement in Europe and the Americas, but ranging increasingly into the Antipodes, Africa, and Asia, psychiatric survivor activism has been gaining an ever-higher profile while organizing for systemic change and forging strategic coalitions in defence of psychiatrized people everywhere.
Grassroots advocates, community groups, and international alliances have been spreading their messages of anti-discrimination and inclusion to governments, stakeholder groups, media, and the public alike, in the process working to shift the very discourse of “mental health” from the reigning biomedical model to a paradigm of social provision, human justice, and valorization of diversity.
Organizations like Mind Freedom International (MFI), the World Network of Users and Survivors of Psychiatry (WNUSP), the European Network of (Ex)Users and Survivors of Psychiatry (ENUSP), Mad Pride UK, PsychRights, the Hearing Voices Network (HVN), the National Self Harm Network (NSHN), the Antipsychiatry Coalition, the Coalition Against Psychiatric Assault (CAPA), the National Association for Rights Protection and Advocacy (NARPA), and the International Network Toward Alternatives and Recovery (INTAR) maintain active lobbying, awareness, support, and mutual aid campaigns and—in the cases of NARPA and INTAR—convene regular meetings involving members of survivor-activist, educator, and research communities (Beresford, 2002; Campbell, 1996, 1999, 2005; Coleman, 2008; Crossley, 2006; Morrison, 2005; Sayce, 2000; Speed, 2005; Stastny & Lehmann, 2007). Over recent years, conferences have been hosted by institutions like the City University of New York, Simon Fraser University, Manchester Metropolitan University, Mansfield College (Oxford), and the University of Toronto.7
The Mad movement in Canada, which developed first in Vancouver in 1970–1971 with the Mental Patients Association (Beckman & Davies, Chapter 3) and then spread elsewhere in the years that followed (Shimrat, 1997), from the beginning included critical activism and scholarship that expressed views that were so clearly different from the medical model that formed a nascent “Mad Studies” of its own long before the term came into vogue. Alternative voices arose in print, including Vancouver’s In A Nutshell (since 1971), Toronto’s Phoenix Rising (1980–1990), and Moncton’s Our Voice/Notre Voix (since 1987), all of which wrote about madness from a perspective that was, at times, radical and always devoid of the medical model dogmatism so common among mainline psychiatric publications. With the growth of the Internet and the World Wide Web, international connections, long fostered before this technological development, became much easier to engage in so that Mad movement activists and allies have connected electronically through individuals, groups, and overarching coordinating bodies such as MindFreedom International.
For Mad studies
Since the 1960s and the first wave of the antipsychiatry and mental patient liberation movements, people in resistance against sanism and mind control have been invoking “madness” both as a means of self-identifying, and as a point of entry into the fields of power where their encounters with organized psychiatry, and their very lives, play out. Once a reviled term that signalled the worst kinds of bigotry and abuse, madness has come to represent a critical alternative to “mental illness” or “disorder” as a way of naming and responding to emotional, spiritual, and neuro-diversity.
To work with and within the language of madness is by no means to deny the psychic, spiritual, and material pains and privations endured by countless people with histories of encounters with the psy disciplines. To the contrary, it is to acknowledge and validate these experiences as being authentically human, while at the same time rejecting clinical labels that pathologize and degrade; challenging the reductionistic assumptions and effects of the medical model; locating psychiatry and its human subjects within wider historical, institutional, and cultural contexts; and advancing the position that mental health research, writing, and advocacy are primarily about opposing oppression and promoting human justice.
An ancient and protean concept that English speakers have been invoking since at least the 14th century (Porter, 2002; Scull, 2011),8 in recent years “mad” has flooded back into the language of public culture, and into the work of critical activists and scholars worldwide. For people and organizations engaged in resistance against psychiatry, to take up “madness” is an expressly political act. Following other social movements including queer, black, and fat activism, madness talk and text invert the language of oppression, reclaiming disparaged identities and restoring dignity and pride to difference.
Invoking madness in the interests of resistance and critique also puts into practice Foucault’s ideas regarding the “strategic reversibility of power” through the medium of discourse (Foucault, 1991; see MacLeod & Durrheim, 2002). While no singular usage monopolizes this book, a sampling of chapter excerpts reveals several commonalities of meaning.
“By Mad,” write Poole and Ward (Chapter 6), “we are referring to a term reclaimed by those who have been pathologized/ psychiatrized as ‘mentally ill,’ and a way of taking back language that has been used to oppress.… We are referring to a movement, an identity, a stance, an act of resistance, a theoretical approach, and a burgeoning field of study.”
In Chapter 8 Liegghio writes: “[M]adness refers to a range of experiences—thoughts, moods, behaviours—that are different from and challenge, resist, or do not conform to dominant, psychiatric constructions of ‘normal’ versus ‘disordered’ or ‘ill’ mental health.… madness [is] a social category among other categories like race, class, gender, sexuality, age, or ability that define our identities and experiences.”
For their part, White and Pike (Chapter 17) apply the term madness “to reflect a more inclusive and culturally grounded human phenomenon that encompasses various historically and contextually specific terms such as insanity, feebleminded, mental disorder, and mental illness.” Diamond (Chapter 4) describes “Mad” as “an umbrella term to represent a diversity of identities … used in place of naming all of the different identities that describe people who have been labelled and treated as crazy (i.e., consumer, survivor, ex-patient).” In this sense, she continues, madness can be invoked “to address some of the divisions stemming from psychiatric survivor identity politics, to celebrate a plurality of resistances and subversive acts against sanism.”
Finally, in Chapter 9 Fabris chooses to differentiate between the lower-case “madness,” which has no inherent critical content, and the proper noun “Mad,” which he proposes “to mean the group of us considered crazy or deemed ill by sanists.” In this decisive sense, for Fabris “‘Mad’ is an historical rather than a descriptive or essential category, proposed for political action and discussion.”
At the same time, the term is not uncontested amongst activists and scholars, including contributors to this book (see Burstow, Chapter 5). However much consensus of meaning might exist among our contributors, and however widespread the term in public parlance (our Google search elicited 231 million hits for “madness” and 148 million for “mad”), we embarked on this project and decided on a title with no illusions about the controversy—and downright hostility— that the madness concept can still incite in some circles.
For many practitioners of the psy professions, and for countless others who subscribe to conventional models of mental distress as biogenetic “illness,” to invoke madness is to flaunt deep-seated beliefs about the nature of sanity and reason, and about the condition of being psychiatrically “sound” or “unwell.”
By advancing a program of Mad Studies and Mad activism, we are flagging this book politically, and we are knowingly taking up a subversive standpoint relative to the governing paradigm of psychiatric “science.” By the same token, in any project affiliated with Mad Studies, Mad movement, and antipsychiatry, participants and “stakeholders” will necessarily represent a remarkable diversity of identities and life experiences—not to mention a wide array of understandings about mental wellness and distress, and about the mental “health” system and its role in contemporary society.
How to represent and promote this spectrum of Mad involvement, while maintaining a critical edge and resisting a decline into liberal relativism, remains a political and ethical challenge requiring resilience, reflexivity, the willingness to adapt, and a collective vision of the Mad movement as a living, and constantly evolving, field of political engagement and struggle for social justice. In many respects, to propose a project of “Mad Studies” in Canada is to take an audacious step into the unknown.
For one thing, the full story of Mad Studies has yet to be acted out, much less written down. As David Reville and Kathryn Church observe in their accounts of Mad Studies programming at Ryerson University (Chapters 12, 13), only in the past decade has the term begun to filter into the vocabularies of teachers, writers, psychiatric survivors, and activists in this country and beyond. Further, however we might try to capture the “essence” of Mad Studies in a book such as this, by its very nature the field is inherently in flux and thus defies any effort to pigeonhole.
In this sense, the collection of essays that we have assembled here should be approached more as an interim, and decidedly partial, report than any kind of definitive survey—and, of course, its contents represent our own biases about what matters to the study of madness. For these reasons and others, we cannot even begin to capture the dizzying scope and complexity of ideas, methods, identities, points of reference, and political commitments that the project of Mad Studies embodies, or might or will embody.
To claim completeness or unity of vision would be to gloss the many ongoing controversies, areas of contention, and competing understandings of past, present, and future that are represented in even a selective offering like this book. All of this said, Mad Studies builds on a compelling tradition of critical activism and scholarship—smatterings of which we glancingly chronicle above—which has opened up a wealth of opportunity for 21st-century struggle against psychiatry in its many forms. Accordingly, the practice of Mad Studies is far more a continuation than an entirely new trajectory of inquiry and practice.
In Chapter 20, Louise Tam underscores the importance of this historical legacy: “The Mad movement and Mad Studies have arrived where they are today from more than five decades of resisting against ‘psy’ knowledge (destabilizing diagnostic categories, naming psychiatric violence, resisting pathologization, and creating countercultures).” Additionally, Mad Studies follows in the footsteps of various other classes of “studies” that have established themselves in recent decades—among them, labour studies, women’s studies/gender studies, LGBTQ studies, equity studies, sexuality studies, black studies, disability studies, deaf studies, queer studies, black queer studies, dementia studies, fat studies, religious studies, postcolonial studies, transnational studies, diaspora studies, and communication studies.
In this way, it is perhaps inevitable that “Mad” would get appended to “studies” given the fertile field of specialized “studies” that has developed and the richness of work done on madness across various disciplines. In his important 2008 paper calling for the establishment of Mad Studies as a new “in/discipline” (see also Reville, Chapter 12), Richard Ingram reminds us of the debt that Mad Studies owes to “disability studies perspectives based on a transformative revaluation of the category of ‘disability’” (Ingram, 2008).
For Ingram and others who highlight this key disciplinary connection, the challenge for practitioners of Mad Studies—as with disability studies, deaf studies, and their many analogs— is to pursue this project of “transformative revaluation” by carving out spaces of relative autonomy while simultaneously taking up the many “communalities” and points of intersection between parallel fields of inquiry and action. Such a pursuit must reflect the specificities of Mad experience and politics (and thus is not fully co-extensive with disability studies), just as it seeks to forge strategic coalitions with other peoples in struggle (see Diamond, Gorman, and Tam, Chapters 4, 19, and 20).
In the process, studies that are madly done can “set a minimum threshold,” carving out a critical topography and setting the standards by which radical theory and practice might be pursued as “alternatives to psychiatric, psychotherapeutic, and psychological perspectives” (Ingram, 2008). For those of us teaching and writing in scholarly contexts, they harbour the potential to unsettle the very way we address the subject of rationality and its alternatives, thereby “shaking the foundations of the place of reason, academia, the sum of all disciplines” (Ingram, 2012).
For all of us critically engaged with the powers of psychiatry, counsels Ingram, the objects of Mad Studies are inseparable from the far-reaching aspirations of the Mad movement: “We hope that societies will recover their lost wisdom by coming to recognize once again the tremendous potential that resides in our unorthodox imaginations.… A time will come when our bodyminds are no longer declared incompetent, and are no longer regarded as accidents waiting to happen. A time will come when we can laugh and cry, love and hide, freely, and without fear. A time will come when there will be no punishment for allowing your imagination to run wild” (Ingram, 2008).
In taking up Ingram’s challenge, psychiatric survivors, activists, scholars, and allies from an assortment of sites—including many of the contributors to this book—have been collectively reconnoitering the field of Mad Studies, considering its opportunities, complications, and constraints. Even at this early juncture in its life history, some common themes have emerged.
First, following Ingram (2008), Mad Studies can be defined in general terms as a project of inquiry, knowledge production, and political action devoted to the critique and transcendence of psy-centred ways of thinking, behaving, relating, and being. In this, Mad Studies is steadfastly arrayed against biomedical psychiatry, at the same time that it validates and celebrates survivor experiences and cultures.
Mad Studies aims to engage and transform oppressive languages, practices, ideas, laws, and systems, along with their human practitioners, in the realms of mental “health” and the psy sciences, as in the wider culture. In Rachel Gorman’s words (Chapter 19), “Mad Studies takes social, relational, identity-based, and anti-oppression approaches to questions of mental/psychological/behavioural difference, and is articulated, in part, against an analytic of mental illness.” Second, by its very nature Mad Studies is an interdisciplinary and multi-vocal praxis.
From its beginnings, resistance against psychiatry has germinated in a multiplicity of sites, and it has involved people from every conceivable social position and walk of life. In the academy, as noted above, we find many mutual affinities between Mad and disability studies, and among those engaged in these pursuits. Yet in Canada, as elsewhere, critical scholarship directed at psychiatry and “mental health” is also flourishing in health studies, sciences and medical faculties, along with departments of law, sociology, psychology, history, philosophy, education, communication, English literature, cultural studies, women and gender studies, sociolegal studies, disability studies, and social work. Additionally, in keeping with its in/disciplinary status (Ingram, 2008), Mad Studies subsumes a loose assemblage of perspectives that resist compression into an irreducible dogma or singular approach to theory or practice.
As Jennifer M. Poole and Jennifer Ward advise us (Chapter 6), “there are many ways to take up a Mad analysis.” Third, Mad Studies takes as its principal source, inspiration, and raison d’être the subjectivities, embodiments, words, experiences, and aspirations of those among us whose lives have collided with the powers of institutional psychiatry. By definition and design, Mad people and Mad culture occupy the analytic core, and they/we embody the very spirit, of Mad Studies.
This is not to suggest that the in/discipline does not practise a coalition politics with allies who have escaped first-hand psychiatric regulation and abuse (the very line-up of this book demonstrates otherwise). Still, without the foundation of critical knowledge and action built up over many years through the grassroots advocacy of psychiatrized people, a viable field of Mad Studies would be unimaginable. In Canadian Mad Studies, the political values, canonical texts, methodologies, forms of communication, and blueprints for action—not to mention the heroes of the movement— have all emerged, in various ways, from survivor culture and history (see Burstow & Weitz, 1988; Chamberlin, 1978; Everett, 2000; Funk, 1998; Reaume, 2000; Shimrat, 1997; St-Amand & LeBlanc, Chapter 2; Starkman, 1981; Vogt, 2011).
Fourth, echoing the experiences of other social movements, relations of sameness/ difference weave their way through the language and practice of Mad Studies in complicated ways. As several chapters in this book illustrate, multiple “mental health” constituencies have emerged in Canada (as elsewhere) through the years, all of which share certain common values and perspectives, while positioning themselves variously—often spectacularly so—in their dealings with psychiatry and the “mental health” industry. In the literature of the past generation, such differences have often been presented in binary terms, usually by juxtaposing “consumer” versus “survivor” communities—with the former self-identifying as clientele of a benign but underresourced system, and the latter aligning themselves as victims and adversaries of a fundamentally flawed and abusive industry of mind and body control (Crossley, 2006; Everett, 2000; Morrison, 2005; Speed, 2005).
However, according to Diamond, Burstow, and Gorman (Chapters 4, 5, and 19), such a bifold account ignores the many layers and nuances of Canadians’ engagement with psychiatry and its allied disciplines. Further, it tends to gloss the ongoing push and pull between “consumer” and “survivor” activists and organizations—a tense relationship that, as Bonnie Burstow argues (Chapter 5), cannot be reconciled by simply inserting hyphens or forward slashes, as in “c/s/x.”9
Based on her doctoral research undertaken in Ontario, for example, Shaindl Diamond (Chapter 4) finds no fewer than three distinct but overlapping communities active within the “radical” stream of the movement—respectively, the psychiatric survivor, Mad, and antipsychiatry constituencies—each with its own rich history, collective identity, ideological commitments, repertoire of discourses, and politics of resistance and change. Fifth, Mad Studies is an exercise in critical pedagogy—in the radical co-production, circulation, and consumption of knowledge.
Following Foucault, the practitioners of Mad Studies are concerned with deploying counter-knowledge and subjugated knowledge as a strategy for contesting regimes of truth (Foucault, 1980, 1991) and ruling (Smith, 1987) about “mental illness” and the psy “sciences,” and about those of us who contend with psychiatric diagnoses and interventions. Further, to quote White and Pike (Chapter 17), “In examining how mental health/illness is made sense of, we may also learn who is entitled to participate in the production of mental health knowledge, who has the ability, or inability, to control what becomes ‘common’ knowledge, and moreover, who is permitted, or not, to be seen and heard in the making of MHL [mental health literacy].”
In our 21st-century age of new media we are witnessing an explosion of technologies and methods for practising critical knowledge work of this kind—among them, websites, alternative e-journals, online archives (see Beckman & Davies, Chapter 3), discussion forums, and Twitter (see generally Wipond, Chapter 18). Concurrently, public education remains a key site of radical knowledge work and conscientization (Freire, 1970), with academics pursuing Mad Studies in their role as “negative workers”—a term coined by Italian dissident psychiatrist Franco Basaglia to describe those privileged individuals who “collude with the powerless to identify their needs against the interests of the bourgeois institution: the university, the hospital, the factory” (Scheper-Hughes, 1992, p. 541).
As just one illustration, in Chapters 12 and 13 Reville and Church outline a Mad history studies pedagogy that has evolved (not without resistance) at Ryerson University with a wide protocol of critical learning objectives, which bring a Mad standpoint to the teaching of history, while exploring the role of knowledge and language in both perpetuating oppression and opening up pathways to resistance (Church, Chapter 13).
Sixth, Mad Studies promotes historical memory work that can help liberate us from the particularities of the here and now, and help us connect contemporary antipsychiatry and Mad activism to the legacies of struggles past. A historical consciousness is empowering to the extent that it locates Mad people at the centre of their own narratives, while highlighting the correspondences between past and present movements, stretching our imaginative horizons of time and space, and illustrating people’s capacity to change the world.
Further, by breaking the frame of the present, we can come to appreciate the diversity of Mad experience, along with the many commonalities that bind seemingly disparate people together through time and space. As Shaindl Diamond argues (Chapter 4), to think and act beyond the present means “recognizing that madness is constructed differently in various historical and cultural contexts, and that there is no real basis of inherent or natural characteristics that define an eternal Mad subject.”
It is not surprising, then, that we find Mad people’s history emerging as a cornerstone of Mad Studies in Canada (Reville and Church, Chapters 12, 13; Reaume, 2006; St-Amand & LeBlanc, Chapter 2, 2008; Starkman, Chapter 1), alongside collaborative projects like the Psychiatric Survivors Archives, Toronto (PSAT) (www.psychiatricsurvivorarchives.com) and the History of Madness in Canada website (http://historyofmadness.ca; see Beckman & Davies, Chapter 3) devoted to the recovery and preservation of “patient”- and survivor-centred history. Seventh, along with the cultivation of historical imagination comes the need to engage the structural contexts and relations of power within which Mad subjectivities, embodiments, experiences, and engagements play out.
Towards this end, White and Pike (Chapter 17) advise that we “pay attention to the socio-political and economic processes through which our common sensibilities around mental health and illness are informed, structured, and maintained.” In scaffolding resistance work around systems of power—and, in particular, within formations of governance and the state—Mad Studies can learn much from the practitioners of critical, feminist, and antipsychiatry, many of whom have long been concerned with how capitalism and patriarchy frame and reproduce psychiatric subjugation (see Burstow, Chapter 5; Ingleby, 1980; Scull, 1977; Ussher, 1992).
According to Tam (Chapter 20), only through a structurally informed analysis is it possible to effect a genuine paradigm shift, freeing us from the restrictive study of “discrete intersections” of identity and psychiatry to deploy a fully material analysis of “inter-institutional psy oppression” (on this point, see also Ussher’s (2005, 2011) discussion of MDI theory10). Such an approach has become all the more compelling in the wake of the global neoliberal (counter)revolution, which began in the 1980s and continues to dominate Canadian political economy and culture into this present decade.
As Morrow asserts (Chapter 23), Mad Studies must take into account the many mutual affinities between neoliberalism and biogenetic psychiatry. With its agenda of privatization, consumerism, fiscal restraint, privileging of the “free” marketplace, and wholesale retrenchment of social services, neoliberalism has paved the way for a new “shallow” relationship between the individual and the state (according to Rose (1999), the making of a neoliberal “self”).
In so doing, it has fashioned a new kind of self-monitoring psychiatric consumer whose “mental illness” is purely an individual concern to be managed through self-caretaking, the administration of expert technologies and, where necessary, aggressive health interventions that proceed without any gesture towards the structural roots of human distress. In other words, observes Morrow (Chapter 23), the age of neoliberalism has ushered in the “healthification of social problems.”
Eighth, and following directly from the above, Mad Studies embraces a dialectical perspective on the relations between self and society, between private and public, between subjectivities and social relations, between human agency and social structure, and perhaps most crucially for this book, between the politics of Mad identity and the imperatives of collective struggle against sanism in all its forms. In keeping with this latter commitment, contributors like Poole and Ward (Chapter 6), Diamond (Chapter 4), and Gorman (Chapter 19) invoke intersectionality theory as pioneered by feminist anti-racism scholars like Kimberlé Crenshaw (1991) and Patricia Hill Collins (2000).
“Intersectionality,” write Poole and Ward, “is concerned with how aspects of social identity—such as race and madness, for example—intersect with oppressions such as sexism and heterosexism.” These authors note the critical need to interrogate the role of psychiatry in mediating, and amplifying, a host of crosscutting socio-economic and political forms of discrimination and oppression based on (for example) class, gender, race, (dis)ability, age, culture, nationality, and sexual identity and practice (see, also, LeFrançois, 2013).
As it acts upon other institutions, and in turn is acted upon in what Hill Collins (2000) terms a “matrix of domination,” the psy system cannot be studied in isolation. Just as important, people’s experiences of psychiatrization vary materially, based on their ever-shifting placements along the multiple axes of the matrix. In turn, what it means to be Mad, and to face repression on its grounds, is forever contingent and hinges crucially on these same structural arrangements.
For these reasons, intersectional analysis “is highly critical of dominant constructions of madness, normality, or sanity, recognizing the flawed nature of simplistic dichotomous and oppositional constructions of difference as ‘dominant/subordinate, good/bad, up/down, superior/inferior’” (Diamond, Chapter 4, quoting Lorde, 2007, p. 114).
Ninth, whether it is practised on the streets, in the schools, through the Internet and print media, in the confines of courts, government offices and hospitals, or among community organizations, Mad Studies is part of a wider revolutionary project dedicated to the radical restructuring of the “mental health” industry. In the end, nothing short of wholesale transformation—to our paradigms of thought, to reigning systems of knowledge and communication, and to the institutional structures that embody and sustain psychiatric relations of power—will suffice.
Granted, tactical and strategic differences inevitably abound, the voices of change are sometimes muted and suppressed, and no consensus vision of a post-psychiatric world yet exists (see Bracken & Thomas, 2005; Cohen & Timimi, 2008). Still, with its roots deeply planted in the traditions of antipsychiatry and liberation movements of the 1960s and 1970s, the struggle for social justice in and beyond “mental health” continues to be very much a project of abolition and transformation—of “nonviolent revolution,” in the words of MindFreedom director David Oaks (2008).
For its part, Mad Studies can help inform this project by conducting critical knowledge work, by speaking truth to psychiatric power (Brandon, 1991, 1998), by exposing the system’s many contradictions, and by pointing the way forward. In so doing, Mad Studies harbours the potential to be a truly revolutionary in/discipline (Ingram, 2008), bridging the long-standing divide between scholarship and activism, theory and practice. Tenth, if Mad Studies is to be a revolutionary project, it must also nest itself in the immediate practicalities of everyday human struggle.
As we assembled this collection of essays, countless people continued to contend with the pain, anger, despair, “distress, euphoria, confusion, unusual or visionary thinking, reliving of painful memories, and alternative experiences of reality” that institutional psychiatry chooses to label as “mental illness” (LeFrançois, 2012, p. 7)—an experience that is too often compounded by that profession’s ministrations (however benign the motives may often be).
For those who inhabit the margins of our 21st-century civilization—the armies of lost and outcast people facing a broken system that serves up chemical cocktails and institutional constraints as a hollow substitute for care, compassion, human contact, and the basic requirements of a dignified life—Mad Studies will have little meaning if it cannot offer some sense of an alternative, some measure of hope that the present can be endured and overcome.
To stay relevant and grounded—and to look at psychiatry and society, and act accordingly, from the standpoint of those who encounter power and privation in their rawest forms—is the key practical, ethical, and political challenge confronting critical scholars, writers, and activists in the realm of “mental health.” Moreover, as the contributors to this book repeatedly attest through their actions as much as their words, it is likely the only one that matters in the end.
To practise Mad Studies therefore means engaging our current world of suffering and injustice and seeking to change it, while simultaneously, in the words of Irit Shimrat (Chapter 10), “dream[ing] of a society brave and moral enough to eschew the whole paradigm of mental health and illness, replacing it with the creation of real community, and real help.”
Organization and Contents of the Book
Informed by the issues, themes, struggles, and experiences chronicled above, this book is made up of 23 chapters contributed by Canadian activists, survivors, writers, and academics who have in various ways involved themselves in advocacy against sanism, in resistance against biogenetic psychiatry, and in the pursuit of social justice by and on behalf of psychiatrized people.
Part I, “Mad People’s History, Evolving Culture, and Language,” includes Mel Starkman’s classic essay, reprinted from the pages of iconic survivor journal Phoenix Rising, on the rise of the contemporary Mad movement. Drawing from their historical work on psychiatric systems in New Brunswick (2008), Nérée St-Amand and Eugène LeBlanc explore Madwomen’s encounters with the 19th-century asylum. Lanny Beckman and Megan Davies mobilize their experiences as activist and historian, in turn, to ponder the practices and possibilities of collaborative memory work. Shaindl Diamond addresses the challenge of building communities of activism in the Toronto movement as elsewhere, while Bonnie Burstow considers the politics of naming in the struggle against psychiatry.
In Part II, “Mad Engagements,” Jennifer M. Poole and Jennifer Ward embrace the practice of Mad grief as a means of resisting psychiatric science’s colonization of bereavement, and its pathologization of those grievers who transgress or offend; Ji-Eun Lee mines the rich legacy of writings by Canadian psychiatric survivors to chronicle the systemic, symbolic violence they have endured and overcome; Maria Liegghio draws on poignant personal experience to illustrate the power of biogenetic psychiatry to efface the identities and selves of those under its remit; and Erick Fabris reflects on the personal and professional politics of peer support in the contemporary mental health system.
Part III is entitled “Critiques of Psychiatry: Practice and Pedagogy.” The four chapters compiled in this section include reflections by Irit Shimrat on the toxic sham that is the “community mental health” paradigm, and by Don Weitz on electroshock as an expression of systemic psychiatric violence. Accompanying these two critiques by long-standing members of the Canadian survivor community, David Reville and Kathryn Church tell the inspiring story of Mad education at Ryerson University.
Part IV, “Law, Public Policy, and Media Madness,”11 includes offerings by Lucy Costa on law as a potential resource and forum for Mad activism; by Gordon Warme on the dominance of the “mental illness” paradigm and its implications for psychiatric power and human rights; by Lilith “Chava” Finkler on contesting restrictive zoning and the exclusion of psychiatric survivors from urban spaces; by Kimberley White and Ryan Pike on the contradictions of “mental health literacy” as a system initiative; and by Rob Wipond on contesting conventional wisdoms about “mental illness,” and bringing critical psychiatric survivor perspectives into public view through engagement with mainstream media.
Part V, “Social Justice, Madness, and Identity Politics,” concludes the book with five chapters that map the convergences and fault lines between Mad identity and political activism. Rachel Gorman offers a cautionary treatise on the praxis of Mad nationhood—on the imperative that Mad citizens pursue a critical politics in solidarity with survivors of racism, colonialism, patriarchy, ableism, and related forms of material and cultural oppression. Louise Tam proposes a paradigm shift in thinking about relations amongst racism, colonialism, and psychiatry—one that seeks to expose the raced material foundations of psychiatric power.
Andrea Daley explores the charged politics of navigating queer identity within and across the psychiatrized spaces of body, intersubjective consciousness, and organizational structure. Jijian Voronka shows how Ontario’s 2008 Review of the Roots of Youth Violence promotes a psy-centred agenda for understanding and repairing the “individual” troubles of risky, racialized, inner-city slum youth. Lastly, Marina Morrow ponders the promises and perils of “recovery” as an “alternative” paradigm of mental health practice within the shadow of contemporary neoliberalism and biogenetic psychiatry.
Read together, the essays showcased in this book chart the many pathways through which sanism enters modern culture, along with the multiple forms of exclusion, discrimination, and human rights abuse inflicted on those of us deemed to violate reigning standards of normality and reason. Writing across a broad spectrum of topics and perspectives, the authors document the exceptional powers that biogenetic psychiatry has arrogated to itself in this 21st century—often with the open consent, if not at the very behest, of political authorities, lawmakers, opinion leaders, “stakeholder” organizations, the corporate sector, the mainstream media, and the public.
As we will witness throughout the pages of this book, these powers constitute a litany of prerogatives and presumptions—among them, the right to constitute and judge mentalities; to distinguish authoritatively between “sanity” and “disorder”; to characterize the latter as an “illness” like any other; to manufacture words and systems for labelling, cataloguing, and containing Mad conduct and people; to impart discipline in the name of science; to intervene, often without consent, into the lives of others; to unleash an arsenal of chemical, electrical, and other bodily interventions under the guise of compassion and cure; and, perhaps most formidable of all, to influence the very languages, thoughtways, and social practices by which we collectively determine what it means to be “normal,” worthy, and even human.
Yet at its core, this book is not just a story of biomedical psychiatry and its everadvancing encroachment into the lives of Canadians. Navigating a remarkably wide landscape of institutional sites and human experiences, the authors are far more concerned with matters of critical engagement—with marking the cracks and boundaries of the psycho-pharmaceutical empire; with building on the legacies of mental patient liberation, Mad pride, antipsychiatry, and the c/s/x movement; with fashioning subversive vocabularies, co-operative alliances, and political strategies for the 21st century that promote individual recovery, collective resistance, and social transformation; and with finding means of speaking and writing the facts of human diversity, in all its forms, in ways that contest the biogenetic paradigm of “mental illness” and celebrate our right to be different. In this basic sense, Mad Studies is simultaneously a continuation of the antipsychiatry project of activist organizing and dissent, a venture in the politics of Mad identity and survivor nationhood, and an exercise in Freirean conscientization directed towards all those whose lives collide with the powers of psychiatry (that is, in one way or another, well-near everyone).
As several of the chapters below attest (see Diamond, Burstow, Fabris, and Gorman, Chapters 4, 5, 9, and 19), the creative tensions that exist between these different currents of the field open up exciting possibilities for mutual teaching, empowerment, partnership, and support. They also admittedly raise complications, and occasional disagreements, about how best to mobilize for change, while both searching for unity of identity and purpose, and embracing difference. Yet while some may possibly demur, we see no irreconcilable conflicts of purpose among these intersecting objectives and pursuits.
To the contrary, the Mad movement is necessarily a poly-sited venture, and the struggle for human rights in “mental health” arrays itself organically across multiple fronts, forms, and levels of involvement. As can be learned from other social movements aligned against capitalism, patriarchy, racism, colonialism, ableism, ageism, adultism, heteronormativity, and environmental desecration, there is no single script for subverting power and doing justice. Nor, as noted above, is there any unitary vision of what a post-sanist society might even look like. While the spirit of revolution is an intrinsic element of every collective struggle, so too is an embrace of immediate challenges, an engagement with the local and short term, a willingness to accept and leverage contradiction, a passion for coalitionbuilding, and a commitment to work with and through pre-existing institutions such as law, education, and the media (see Reville, Church, Costa, and Wipond, Chapters 12, 13, 14, and 18)—and perhaps even the psy sciences themselves.
To the extent that a discipline of Mad Studies can embody this kind of heterodox vision, positioning itself loosely between and around the multiple ideas, voices, and practices of Mad movement, survivor politics, and antipsychiatry activism (Diamond, Chapter 4), its place as a forum of communicative action, and a force for critical teaching and learning, is assured for many years to come. Ultimately, as the title of this book implies, our project is grounded in the paradigmshifting awareness that Mad Studies is about far more than the Byzantine world of psychiatry and its allied disciplines. The stakes are higher still, for to study madness is to probe the very foundations of our claims to being human. For this reason alone— and there are many more—“Mad” matters to us all.
1 This wording is adapted from the opening sentence of the introduction to Titchkosky & Michalko (2009).
2 Having originated in the 1850s as the International List of Causes of Death, the International Classification of Diseases now falls under the auspices of the World Health Organization (WHO). Its most recent iteration, ICD-10, has held sway since 1994. See www.who.int/classifications/icd/en/.
3 This is not to suggest that there are not children who experience serious forms of distress that are debilitating and painful to them. Instead, this is to stress the proliferation of diagnoses given to children who are not experiencing distress from their perspective but may be experienced as distressing to the adults that are around them. These same distressing (to adults) behaviours of children were tolerated, and seen as within the range of “normal” childhood behaviours, in earlier generations.
4 These include the same drugs given to psychiatrized adults, such as selective serotonin reuptake inhibitors (SSRIs), neuroleptics, anti-anxiety drugs, and tranquilizers.
5 An example of such a Canadian organization is the National Youth in Care Network or Youth in Care Canada. See www.youthincare.ca.
6 As such, as editors of this reader, we must acknowledge the absence of the direct involvement of psychiatrized children in this book as an unacceptable exclusion. However, the lack of involvement of children within the psychiatric survivor and Mad movements in Canada (and elsewhere)—an exclusion that the adults in our communities must take responsibility for and understand as stemming from adultism—and our own lack of access to psychiatrized children at the time of organizing and writing this text, have inevitably led to this regrettable exclusion.
7 For details on these international events, see www.sfu.ca/madcitizenship-conference/ (Madness, Citizenship and Social Justice, Simon Fraser University, 2008); http://individual.utoronto.ca/psychout/ (PsychOUT 2010, Ontario Institute for Studies in Education, University of Toronto); www.theopalproject.org/psychout.html (PsychOUT 2011, City University of New York); www.inter-disciplinary.net/probing-the-boundaries/making-sense-of/madness/project-archives/4t/ (Madness: Probing the Boundaries, Mansfield College (Oxford), 2011); www.asylumonline.net/ (Asylum! Conference, Manchester Metropolitan University, 2011). Retrieved January 26, 2012.
8 On the English-language etymology of the terms “mad” and “madness,” among other sources see www.etymonline.com/index.php?term=mad.
9 “Consumer/survivor/ex-patient.” See above, in addition to (among other sources) Diamond, Chapter 4, and Burstow, Chapter 5.
10 In her book, The Madness of Women (2011), Jane Ussher proposes the material-discursiveintrapsychic model as a critical realist approach to the study of (women’s) madness. For Ussher, MDI “moves beyond the mind-body divide or realism-constructionism divide, and avoids the unnecessary distinction between subjective and objective, or mental and physical aspects of experience” (p. 106).
11 Our reference to “media madness” is beholden to Otto Wahl’s (1995) book of that title.