Drugs, Anti-psychiatry and Cognitive Liberty

7/27/2019 Drugs, Anti-psychiatry and Cognitive Liberty

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imbalances of hormones, neurotransmitters, etc., and therefore the only

effective treatment is pharmaceutical (with, if you're lucky, a side order of

diet and/or exercise), or it's entirely social in nature, caused by problematic

interpersonal relationships at either the individual/family or wider society

level. Both these positions intensely frustrate me, because neither of them

allows for the possibility that - shock horror! - it might be sometimes one andsometimes the other, or even - unthinkably - sometimes both...

I understand why most radical critics of psychiatry tend to fall for the latter

position - it is undeniable that Capitalism in the form of the pharmaceutical

industry and State repression in the form of coercive psychiatry and the

institutional system collaborate in the forced drugging of neurodivergent

and/or distressed people (just as in different forms they collaborate

throughout modern state-capitalist civilisation). It also superficially fits well

with the social model of disability to locate the roots of unhappiness insociety rather than in the individual (although only, IMO, if one doesn't fully

understand the distinction between "impairment" and "disability"). But it's

also worth noting that approaches to the "treatment" or "management" of

mental distress that regard it as social or interpersonal in origin - such as the

many and varied forms of counselling, psychoanalysis, cognitive behavioural

therapy, etc. - can be as easily, and have been as often, corrupted into

individualising, victim-blaming forms to serve paternalistic and authoritarian

ends as biochemical approaches (for just one example outside a state-

coercion context, see here, but it's been done plenty of times by states too).

This also strikes me as parallel to the equally frustrating recurring

"nature/nurture" debates about queer and trans identities, with regard to

whether sexual orientation, gender identity, etc., are biologically innate or

socially constructed. In both cases, anyone aiming for a joined-up, radical

liberation politics will get fatally sidetracked if their argument depends on it

being either - because, as i've written before with regard to sexual

orientation, ultimately, if you believe in liberation and acceptance for all, why

should it matter?

Therefore, anti-psychiatry does not have to mean anti-drugs, and the

reduction of the concept of anti-psychiatry in the public perception to merely

opposition to anti-depressants and other psychotropic drugs is in fact deeply

harmful and trivialising of the serious and powerful critique that, IMO, a

synthesis of the various strands (libertarian, Marxist/post-colonialist, and


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feminist) of it offers to many of the foundations of modern, "mainstream"

Western society. Unfortunately several of the more prominent groups in the

anti-psychiatry movement, such as Mindfreedom International (which, i

hasten to add, i thoroughly support in all their core aims), for the reasons i've

outlined, tend towards not just an "anti-forced-drugging" but a blanket "anti-

drugs" direction, which is probably most exemplified by Peter Breggin -possibly the best-known currently active figure in anti-psychiatry - who has

essentially made a whole career out of attacking (often justifiably, it has to be

said, but rather unilaterally) SSRIs, stimulants like Ritalin, and other doctor-

prescribed psychotropic drugs. However, Breggin's views on autism show that

his opposition to such drugs comes not from anti-coercion principles, but from

the false ideology that mental distress and/or neurological difference (which

he conflates just as much as the dominant paradigm of psychiatry does) are

"all social, never biological", which leads him to regurgitate the same old,

offensive and disproven "blame the parents" theory espoused by the likes of

Leo Kanner and Bruno Bettelheim (with his "refrigerator mothers") - which

does as much genuine harm to autistic people and their families as forcibly

drugging them does.

In Mindfreedom's case (as Amanda Baggs covers in this excellent post), the

blanket anti-drug stuff is essentially just a veneer on top of a basically sound

core of opposition to the oppression inherent in a paternalistic, coercive

psychiatric system (and has also been toned down noticeably with the most

recent overhaul of their website, although their "Knowledge Base" is still

heavy on the information - which is massively important and necessary -about the dangers of psychiatric drugs), but as far as people like Breggin are

concerned, because of their acceptance of false dichotomies, opposition to

drugs seems to have become more important than opposition to coercive

psychiatry itself.

Far from being part of the fight back against state paternalism, telling all

people with mental distress and/or cognitive impairments that they should

never take any prescribed drugs, even if they experience desirable effects

(which, incidentally, might well not be the same effects that the prescribingdoctor intended them to have, given how much of a crapshoot such things

are) from them, is paternalism! It also shades seamlessly into the very ugly

pop-cultural tendency to deny the real existence of mental distress or to

assert that every problem can be beaten using only "positive thinking" or

other kinds of magical bullshit, which - as genderbitch deconstructs

magnificently here - comes from the nastiest and most ignorant forms of non-

disabled privilege.


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Both the blanket pro-drug and the blanket anti-drug positions fail at liberation

for the same reason - that they presume a single truth to be applicable to all

people who are experiencing mental distress, and prescribe an exclusive

range of possible solutions (either always drugs, as necessary if notsufficient, or a somewhat wider, but still by definition exclusive, class of

approaches not involving drugs)... yes, we're back to prescriptivism - which

has no more place in the movement against coercive psychiatry than it does

in any other liberation movement.

It's also a logical fallacy to assume that SSRIs and similar drugs are somehow

inherently "evil" and coercive simply because they are used, pushed and

prescribed primarily in a coercive manner in the society that we currently live

in - just as it's equally illogical to assume that recreational drugs likecannabis, LSD or MDMA ("ecstasy") are either inherently "evil" because they

are illegal and therefore linked to violent crime, or inherently "good" because

the statist-industrial complex represses them and persecutes people who use

them. In any logical libertarian way of looking at things, "mind-altering"

substances are in themselves ethically neutral, regardless of whether they

are presently promoted or prohibited by the ruling system - yet it can be

surprisingly and frustratingly difficult for me to explain - even in "left-

libertarian" circles - that my opposition to forced drugging isn't about the

effects of the drugs themselves - although those effects can seriously fuck

people up, including leaving people with serious impairments, both physical

and cognitive, that they didn't have before - but about the fundamental

principle of autonomy - it would be wrong, because a violation of an

individual's autonomy over their own mind and body, to forcibly drug

someone even if the effects of that drug were wholly beneficial.

(In fact, as a generalised maxim, about the only thing [or class of things?]

that i think is inherently "wrong" is that which is done to sentient beings

without their consent. I also think that's about the only usefully workable

definition of the concept of "evil".)

The concept which transcends the false dichotomy of "pro-drugs" and "anti-

drugs" positions is that of cognitive liberty (see also the Center [sic] for

Cognitive Liberty & Ethics' FAQ on the subject). Defined as "the right of each

individual to think independently and autonomously, to use the full spectrum

of his or her mind, and to engage in multiple modes of thought", cognitive


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liberty ought to be central to any (whether "left" or "right") libertarian

politics, and yet it's shocking and deeply disappointing how often i see

positions antithetical to it held by people who honestly consider themselves

libertarians.

Thankfully the concept of cognitive liberty has been combined with anti-

psychiatry. Notably, Ken Kesey, author of the great anti-psychiatrist novel

One Flew Over The Cuckoo's Nest, was a prominent advocate of the

recreational use of hallucinogens and other drugs, yet his novel is one of the

most powerful attacks on the fundamental authoritarianism and human-

diversity-destroying aims of psychiatry [whether or not you regard it as using

the psychiatric institution as a metaphor of wider American/Western society -

which i certainly think is a valid reading, but IMO one which doesn't preclude

more literal readings from being valid as well) ever written, as well as the

only novel which, for me, really expresses - in ways i couldn't begin todescribe in words - the true horror of paternalism in action and of the "for

your own good" justification for oppression. It's also notable that OFOtCN can

be seen as something of a distillation of both major early strands of anti-

psychiatry - the "right-libertarian" strand exemplified by Thomas Szasz, with

its motif of comparisons to state-socialist totalitarianisms (see McMurphy's

several comparisons of the hospital to a "Red Chinese prison camp"), and the

vaguely Marxist/"leftist" but also vaguely "New Age"-influenced existentialist

approach of the likes of R.D. Laing (which, incidentally, was the original "anti-

psychiatry", despite the fact that the term tends to be identified more with

Szasz's libertarian approach in current usage).

(I'll note that while One Flew Over The Cuckoo's Nest is among the novels

that have most profoundly influenced me on a huge number of psychological,

ideological and conceptual levels, i'm fairly sure there are aspects of its

treatment of race, gender and perhaps other identity issues that deserve

serious critique - i'd love to see Native American perspectives on the

character of "Chief Broom", for example - but this is an aside for now, as this

post wasn't intended to be about Kesey or OFOtCN as such...)

(I should also note that Szasz, for all his faults (which i'm going to discuss in

another post at some point), supports the right of individuals to take all the

drugs they want, even though his criticisms of the effectiveness of the drugs

mainly prescribed by psychiatrists at the time probably formed some of the

foundations of the present absolutist anti-drug position among much of the


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anti-psychiatry movement.)

As a final point that i think brings me nicely full circle, a bit of looking around

Lennard Davis's site brought me to Project Biocultures, which appears to be

doing exactly what i think is most necessary to get past ideological traps

such as the unhelpful "pro-drugs"/"anti-drugs" dichotomy - crossing those

boundaries in order to break down "the artificial separation of categories of

science, medicine, technology and the social sciences and humanities", while

also attempting to break the barriers between the top-down world of

academia and the marginalised people who are likely to be its "subjects". In

many ways, disability (including "mental health" and neurodiversity) stands

right at the most crucial intersection between the "two cultures" of "science"

and "the humanities", the "objective" and the "subjective", the social and the

biological - and neither a purely social, nor a purely biological, perspective,

but only one which transcends such dichotomies, is sufficient for dealing withthe full personal and political reality of it.

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Drugs, Anti-psychiatry and Cognitive Liberty