Review from the Canadian Journal of Disability Studies, Vol 5, No 1

Burstow, B. (2015). Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. New York: Palgrave MacMillan.
ISBN: 978-1-137-50384-8.

Reviewed by Jennifer Poole, Zachary Sera Grant & Katherina Yerro
School of Social Work, Ryerson University
jpoole [at] ryerson [dot] ca

Original Article: http://cjds.uwaterloo.ca/index.php/cjds/article/view/260/474

It is rare to come across a scholarly book that one cannot put down. It is rare to come across a book that unequivocally demands we step “outside the circle of certainty” (2) around “mental” “illness” and “care.” This is such a book, and in it we have a clear argument for what psychiatry has become, what it is capable of, and how this all came to pass.

We have heard echoes of this argument from scholars situated in the fields of anti-psychiatry, critical mental health, and Mad studies. Yet, for us, three social work scholars at various stages of our careers, the breadth and depth of Burstow’s accounting is not only spectacular but new. In a clear and accessible way, Burstow takes us through personal, historical, narrative, institutional, economic, political, and discursive landscapes. She shows us how each is a part of her particular “study of psychiatry” (1) and “all that surrounds it” including governments, the legal system and “mechanisms of enforcement” (2). Importantly, she shows us what the consequences of it all have been on our friends, family members, colleagues, and ourselves. Burstow is not afraid to question the whole mental health system, and how it has come to be that “people believe what medical doctors state and what medicinal doctors recommend” (3). Boldly, she asks, “what if this were not legitimate medicine…what if psychiatry’s fundamental tenets and conceptualizations were inherently faulty? Indeed, what if – despite some helpful practitioners – it does far more harm than good” (1)?

We have long suspected the same, and so we welcomed Burstow’s accounting. With such a book there is much to be made of all her arguments, but for us, certain sections stand out more than others. Of note were Chapters 2 and 3 which we see as difficult but mandatory reading for those interested in the history of psychiatry, “mental health,” and “helping.” In the former, Burstow takes us back to classical times, to witch hunts, to the power of the Catholic Church, the birth of psychiatry and its terminology and classification system. We enjoyed Burstow’s take on Pinel, usually presented as a hero for unchaining the mad. She writes, “what we have with Pinel, in other words, is not the end to brutality as professed but a more subtle form of brutality” (35) and one tied up in “confinement on an unprecedented scale” (44). Chapter 3 is a terrifying tour of modernity, as well as the challenge of psychoanalysis, psychiatry’s role in eugenics, the Holocaust and of course the pharmaceutical revolution. As Burstow notes in her conclusions, images from these chapters continued to haunt us long after we closed the book.

We must also commend Burstow’s detailed discussion of the DSM in Chapter 4, and the utility of her demonstration of how “things” come to be included or not in this oh so powerful text: “Criteria sets pathologize the everyday [e.g., General Anxiety Disorder] and … routinely pathologize deviance [see Oppositional Defiant Disorder, Schizophrenia, Borderline Personality Disorder], they are blatantly sexist, racist, classist, transphobic” (92). In this chapter, we are also gratefully reminded that, “No biological sign has ever been found for any ‘mental disorder.’ Correspondingly, there is no known physiological etiology” (75).

Similarly, Chapter 5 on the “beast” that is psychiatric “care” had personal resonance for us as did Chapter 6 on the co-option and “hooking” of the professional. We nodded in recognition at what professionals tell themselves to rationalize clinical decisions and the nursing interviewee who admitted, “I can’t do this anymore…I tried to speak up, but the power of the script is too big for me” (143). And then there are the chapters on “pharmageddon” (Chapter 7) and electroshock (Chapter 8). Even for those of us who might be familiar with this content through multiple encounters with the “system,” these are troubling chapters, for they detail how these “treatments” come to be approved and how they “work,” including the cherry picking that goes on in clinical trials, the silencing of adverse effects, the lack of testing on ECTand the admission that ECT produces results similar to brain injury.

We must also note that Burstow has created one of the best examples we know of institutional ethnography (IE). “A culmination of decades of research” (16), the book is based on 119 interviews as well as analysis of hundreds of documents and observations (p. 16). Although she also includes other forms of research such as critical discourse analysis, after reading this book we have the sense that this is how we “should” be doing IE. Citing Smith (2005, 2006) and staying true to the language and process of IE (i.e. regime, problematic, boss text), Burstow offers the reader many a “point of disjuncture” (3), showing us how to then go “where the documents point” (10).

Indeed, this book is a detailed IE account of the strangle-hold psychiatry has on so many. We believe this text should be core reading for anyone in the helping professions who is unaware of or has forgotten how psychiatry controls and manipulates those under its authority. As service users, we appreciated being able to relate to stories of other survivors included in the text. As educators and students, we appreciated all the effort that Burstow has put into this brilliant new text.

However, we do have questions.

While we believe this book to be a much needed compilation of the intersectional oppression of psychiatry, some of us struggled with a general lack of suggestions for our own critical mental health work. If, as Burstow asks, there must be a better way, we need more details on what that way is. Agreed, compassion is central, as is listening, believing, and working together in “the commons,” but how do we get there? How do we start on that path? Who can make this happen?

Secondly, after reading this book some of us are also troubled by an even greater fear of psychiatry. In the words of one interviewee in the book, “we have seen psychologists mysteriously disappear… there is a real fear of saying anything against the grain, let alone coming out against a treatment” (156). When do we speak up against psychiatry? How do we speak up? Can we, as Burstow notes, take down the system a la “Trojan horse”? It is far easier for those with tenure, with social and educational capital, with stable housing and white privilege to ask the questions than those starting out in this work, living with debt and precarity, as well as with oppressions such as transphobia, heteronormativity and racism.

We also had questions about how Burstow problematizes so much psychiatric language in the book but, in Chapter 5, does not do the same with “eating disorders.” To write “like many a young woman in this society, she is anorexic” (135) is not only counter-productive but demonstrates the author’s own “institutional capture” (another IE term). While we do not believe Burstow intended to make an overarching judgment about women in society, we do believe it to be an excellent example of how psychiatry functions, when a leading anti-psychiatry activist, in a book about psychiatry as a means of social control, can themselves make a statement which perpetuates, in her words, the “misogyny” (95) ever present in theDSM.

As well, many readers of this book may be left wondering about Burstow’s focus “on the west” (22) and the inadvertent centering of all things western, including whiteness. Although there are sections where race and racism are taken up (see Chapter 2 for instance), there is very minimal attention given to colonialism and “all that surrounds it” vis-a-vis psychiatry. Although Burstow takes up what she calls “Aboriginal worldviews” in her final chapter envisioning a “eutopian” world, it is a cursory mention, without credit to any particular scholar, elder, teacher, or nation. And at this time, in this place, we see this exclusion, this de-centering, as colonialism once more. Cannot settlers, even expressly anti-psychiatry settlers, do better?

Finally, we are left with a question of what does this book offer disability scholars? While there is no mention of critical disability studies per se, Burstow does cite and include multiple references to scholars important to disability work and especially that which takes a critical look at “mental disability.” LeFrancois, co-editor of the Canadian Mad Studies collection Mad Matters is both interviewed for the book as well as cited as a scholar, as is Chris Chapman and Irit Shimrat. Burstow also locates her work in a tradition of critical scholars such as Szaz, Foucault, and Fanon “committed to revealing what might be called the hidden face of psychiatry” (20). To this list she adds feminist scholars Chesler, Showalter, and Caplan, as well as Erick Fabris (2011). But it is Peter Breggin (1983, 1979) and David Healy (2009) who are especially referenced throughout. Clearly, this situates Burstow’s argument alongside a more classic canon rather than a contemporary Crip commentary. And we could not help but wonder what scholars such as China Mills, scholars troubling psychiatry and colonialism, might make of this particular orientation.

Struggles and questions aside, this is an important book. It made us question a good deal of what we “know”; personally and professionally, and we have already recommended it to colleagues, friends, and students. Gratefully, we are left with even more questions about the system, about those who find psychiatry helpful, and about what is next, both for Burstow, and for us.

References

• Breggin, P. (1979). Electroshock: Its brain-disabling effects. New York: Springer
• Breggin, P. (1983). Psychiatric drugs: Hazards to the brain. New York: Springer
• Fabris, E. (2011). Tranquil prisons. Toronto: University of Toronto Press.
• Healy, D. (2009). Psychiatric drugs explained. London: Elsevier.
• Lefrancois, B., Menzies, R. and Reaume, G. (2013). Mad matters: A critical reader in Canadian mad studies. Toronto: Canadian Scholars Press.
• Smith, D. (2005). Institutional ethnography: A sociology for the people. Landham, MD: Altamira Press.
• Smith, D. (2006). Institutional ethnography as practice: Landham, MD: Rowman and Littlefield.

Review from Ethical Human Psychology and Psychiatry 17.1 (2015): 76-80.

Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. Bonnie Burstow. London, United Kingdom: Palgrave Macmillan, 2015, 316 pp., $40.00 (paperback) $95.00 (hardcover).

This book is arguably the most comprehensive and brilliant critique of psychiatry that I've ever read; it's a devastating expose of psychiatry's discredited medical model and institutional psychiatry, "a regime of ruling." Bonnie Burstow's book is absolutely awesome in its numerous, thoroughly researched facts and original insights and scholarship frequently voiced with passion. Burstow uses the research analytic tool of institutional ethnography-"ruling happens through texts, particularly through the activation of texts" (p. 18). With this powerful intellectual probe, she deconstructs "boss texts" and takes us on an incredible journey into psychiatry, its alarming methods of social control, its intrusive brain-damaging drugs and electroshock. Burstow ends this awesome work in the spirit of hope and humanity she calls "Eutopia," a vision of a better world of compassion, empathy, mutual caring, respect for freedom and human rights.

She begins with a short and concise history of psychiatry featuring mad doctors and "alienists" (an apt word) during the 18th century, including Philippe Pinel who unchained poor people with mental illness in a Paris asylum but instituted a reign of terror of close surveillance and control. In the 19th century, there's Benjamin Rush, the notorious "father of American psychiatry" whose face appears on the American Psychiatric Association's logo; he invented the traumatic "tranquilizer chair" and advocated fear as therapeutic; he also labeled black slaves with the disease of "drapetomania," running away to be free; he also committed his son to an insane asylum. The gentler "moral treatment/moral management" of country retreats in the late 18th and early 19th centuries soon died; by the late 19th and early 20th century, it was replaced with eugenics/genetics-based, physically intrusive biological psychiatry, which unfortunately dominates today. This is a small but telling fragment of psychiatry's dark history of social control, medical fraud, coercion, and violence.

Burstow asserts that two fundamental principles underlie psychiatry and the book: parens patriae and police powers. Parens patriae (literally "father of the country") refers to power of the state to control, imprison, and forcibly treat citizens; police powers are mainly expressed as coercion, arrest, and use of force. Psychiatry, Burstow asserts, is essentially a regime of ruling; however, given psychiatry's hegemonic social control, the terms psychiatric dictatorship and psychiatric police state seem more appropriate.

In Chapter 4 ("Probing the Boss Text: DSM-What? Whither? How? Which?"), Burstow brilliantly analyzes the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry's bible of fraudulent diseases. Unlike medical diagnoses, the approximately 350 diagnostic labels in DSM-5 (the current edition) are not only subjective and unscientific but also frequently lead to serious life-changing consequences such as loss of freedom (involuntary commitment), psychiatric drugging, and/or electroshock (electroconvulsive therapy [ECT]). DSM labels, Burstow asserts, serve no medical or scientific purpose, instead they routinely marginalize and stigmatize. Burstow succinctly summarizes major problems of the DSM, "subjectivity . . . masquerading as objectivity . . . nothing less than the essence of who the person is . . . constitutes a disorder" (pp. 94-95). She calls this activating text a "patient-processing system," denounces it as having absolutely no scientific validity or reliability; like the late psychiatrist Thomas Szasz and other dissident health professionals, Burstow correctly states there is "no mental illness" because there is no biological or medical evidence of cellular disease in anybody labeled mentally ill. With surgical precision, she exposes the fraudulent nature of DSM diagnoses while examining constructs such as "personality disorder," "oppositional defiant disorder," "schizophrenia," and "attention deficit/hyperactivity disorder (ADHD)," all allegedly types of "brain disease" caused by the discredited "chemical imbalance" theory. What's going on here is irrationally medicalizing nonconformist behavior, in fact virtually any intense emotional state-for example, sadness or grief labeled "depression," joy labeled "hypomania," and most everyday problems as "mental disorders." The DSM is the modern equivalent of the Inquisition's Malleus Maleficarum, a medieval boss text of written instructions ("criteria" or "symptoms") designed to identify and demonize heretics and witches-today's "mental patients." In short, "human existence itself [is] . . . theorized as . . . a disorder" (pp. 89-90); "problems are located exclusively within the individual . . . something that conflicts with Aboriginal experience, not to mention that of most of the world" (p. 92). This is not medical diagnosis or "medical science," it's psychiatry-and-state-sponsored quackery.

Another clear and important message is "psychiatry is an agent of the state." In this connection, Burstow examines relevant sections of Ontario's Mental Health Act (MHA; Chapter 5, "The Beast/Inside the Belly of the Beast: Pinioned by Paper"). Like virtually all mental health laws and regulations, the MHA legitimizes preventive detention as involuntary committal (incarcerating citizens without charge and public hearing or trial); it also falsely assumes that psychiatrists can predict dangerousness. As an example, Burstow cites these sweeping and vague criteria for involuntary committal:

The patient is suffering from mental disorder of a nature or quality that likely will result in:

(i) Serious bodily harm to the patient,

(ii) Serious bodily harm to another person, or

(iii) Serious physical impairment of the patient unless the patient remains in the custody of a psychiatric facility. (p. 107)

The term mental disorder is not specifically defined here or anywhere else in the act. Also, the term likely will result is a guesstimate, not medical evidence or scientific fact, because psychiatrists admit they cannot predict dangerousness; the term serious physical impairment is obviously, if not deliberately, vague and open to multiple interpretations. As ruling words, these criteria make it very easy for psychiatrists to label and lock up and chemically restrain (forcibly drug) innocent citizens for at least 72 hours under the "Observation and Assessment" provision in Form 1. The incarceration and forced drugging of Irit Shimrat, a close friend, courageous survivor, and author, is very relevant; her story is a frightening object lesson in psychiatric-and-state-sponsored coercion and violence (pp. 123-124). Compounding this injustice, during the initial "period of observation and assessment," the person cannot appeal or launch any legal action. Even more alarming, Burstow points out that people can also be involuntarily committed (lose their freedom) if they refuse to "take their meds," or if they've "previously received treatment or from a mental disorder . . . and likely to suffer substantial mental or physical deterioration or serious physical impairment" (p. 109). Again, this major term is not defined or explained. Equally alarming, the MHA greatly expands police powers such as authorizing police officers in Ontario the power to diagnose mental disorder, predict dangerousness, arrest, and forcibly transport citizens to psychiatric facilities for psychiatric examination mainly based on subjective belief:

A police officer has reasonable and probable grounds to believe that a person is acting or has acted in a disorderly manner and has reasonable cause to believe that the person,

(a) Has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;

(b) Has behaved or is behaving violently toward another person and has caused or is causing another person to fear bodily harm from him or her; or

(c) Is showing a lack of competence to take care of himself or herself, and in addition the police officer that the person is apparently suffering from a mental disorder of a nature or quality that will likely result in,

(d) Serious bodily harm to the person,

(e) Serious bodily harm to another, or

(f) Serious physical impairment of the person.

Burstow comments, " . . . evidence that officials are permitted to use in making their assessments includes not simply what they directly observe but also what is relayed by others. The 'mentally ill person' becomes 'an easy target.' People can be committed against their will simply because they are not taking their meds." Many survivors stop or try to stop taking antidepressants and/or neuroleptics (antipsychotics) for good reason-they can't tolerate the incredible suffering and disability the drugs cause (p. 110).

Once the person ends up in a psychiatric hospital or mental health center, he or she is subjected to more violence, what Burstow calls "cosmeticized violence . . . students are socialized to give and force damaging treatments on people". In the chapter "The Psychiatric Team," psychiatric and nursing staff violence inherent in physical restraints, forced drugging, and "seclusion" (solitary confinement), for example, is rationalized as self-defence from the perceived or imagined violence of patients "in need of control." In this environment ruled by a hierarchy of psychiatrists, psychologists, nurses, and social workers, violence serves a double purpose-control of patients and enforcement of unity among team members. In this controlled and controlling environment, whistleblowers are nonexistent; team solidarity trumps care, compassion, and empathy.

"Marching to 'Pharmageddon': Polypharmacy Unmasked" (Chapter 7) is an important consciousness-raising object lesson on psychiatric drugs as a major method of social control. The brain-damaging effects of psychiatry's "safe and effective" neuroleptics (antipsychotics)-for example, blunting of emotions, apathy, indifference, cognitive impairment; so are akathisia, tardive dyskinesia, neuroleptic malignant syndrome, and parkinsonism, all are clinical indications of brain damage sanitized as "side effects" of psychiatry's "safe and effective medication." Burstow draws heavily on the consciousnessraising critiques of dissident psychiatrist Peter Breggin, investigative journalist Robert Whitaker, and other independent researchers, as well as her own professional knowledge and experience. Although not a medical doctor, Burstow clearly and critically explains how these drugs, particularly the "atypical" neuroleptics such as Risperdal, Zyprexa, and Abilify that impact several parts of the brain; they seriously disrupt the neurotransmitter dopamine in the mesocortical and mesolimbic systems, invariably causing brain damage or chemical lobotomy. The antidepressants have similar if not more serious brain-damaging effects in addition to causing suicidal ideas, suicide attempts, mania, and sudden violence. The biological psychiatrists, Burstow asserts, falsely claim "chemical imbalance" or lack of dopamine in the brain as the major cause of schizophrenia, for example; psychiatrists, medical doctors, and researchers, largely funded by the drug companies (Big Pharma) continue ignoring the fact that psychiatric drugs cause this chemical imbalance and brain damage, including the tragic and disabling neurological disorders-an admission they're afraid to acknowledge. A person with a previous psychiatric history can be kept on psychiatric drugs virtually indefinitely, thanks to a community treatment order, another boss text that authorizes doctors, not just psychiatrists, to prescribe psychiatric drugs for years or indefinitely to patients after they're released to the community (see Tranquil Prisons by Erick Fabris). Under this draconian mental health law, refusal to "take their meds" can result in people being committed for longer periods. The transnational drug companies also come in for well-deserved criticism for their unscientific research and unethical marketing practices, including mislabeling and hiding many health-threatening effects of psychiatric drugs during clinical trials, major findings are often kept secret. Also, government regulators such as the Food and Drug Administration (FDA) in the United States and Health Canada are shown to be frequently incompetent and complicit in failing to fully warn and protect the public about high-risk drugs.

Burstow is at her most critical in powerfully exposing and denouncing "Electroshock" (ECT), arguably psychiatry's most destructive procedure today, one that many shock survivors and activists have been protesting against for almost 40 years and want banned (Chapter 8). Contrary to popular belief following the film One Flew Over the Cuckoo's Nest, ECT never stopped and never banned but has increased worldwide. Burstow accurately and concisely describes the ECT procedure involving sedative, muscle paralyzer ("muscle relaxant"), oxygen, and electricity; 1501 V are delivered from a shock machine to electrodes placed on one side (unilateral) or both sides (bilateral) of the brain. ECT always causes a grand mal seizure-dishonestly called therapeutic by shock promoters Richard Abrams, Max Fink, the American Psychiatric Association, and Canadian Psychiatric Association. Also, every ECT causes an immediate convulsion, coma, memory loss, and brain damage. Burstow bluntly and concisely comments,

Iatrogenically created dysfunction, Diminished capacity. Lobotomy-like unawareness. Anosognosia-the cognitive impairment that involves inability recognize that one is impaired Compliance itself. Euphoria caused by brain damage . . . after four weeks, this brain-damaging treatment is no more effective than placebo . . . people . . . are being brain-damaged for nothing . . . The most pervasive themes . . . are: memory loss; cognitive impairment; loss of skills, prospects, ability to function, connections itself, with diminishment of the person emerging as an overarching theme. (pp. 215, 224)

The American Psychiatric Association's promotional mantra that ECT is "safe and effective treatment" is directly challenged by several scientific studies that Burstow summarizes. For example, she succinctly explains the significance of Harold Sackeim's landmark comprehensive 2007 study in which he conclusively proves the brain-damaging and memory-destroying effects of electroshock-regardless of type or mode of ECT, placement of electrodes, age, and gender; as prime targets, women and the elderly suffer the greatest damage, reflecting sexist and ageist biases in ECT (pp. 212-213). Electroshock's many devastating and tragic effects come to life with excerpts of Burstow's interviews with several Canadian shock survivors and some of their personal testimony at the 2005 Enquiry into Psychiatry public hearings in Toronto. The statements by Connie, Wendy, and "C's" story are particularly memorable and riveting; they courageously speak truth to power (pp. 216-222).

As organizational-systemic analysis, Burstow's graphic illustrations of the "The ECT Empire" (p. 204) and "Rule by ECT Scholar/Capitalists" (p. 208) are original, accurate, and chilling in their details. They clearly show the interconnections and conflicts of interest among shock promoters such as Richard Abrams, Max Fink, and Richard Weiner with the American Psychiatric Association's task force reports, close links to journals, textbooks, shock machine manufacturers (e.g., somatics owned by proshock psychiatrist Richard Abrams), hospitals, and government regulators such as the FDA and Health Canada. Near the end of this chapter, these conclusions are worth quoting and remembering: "People's lives are essentially obliterated-erased" (p. 217).

The authorities most influential in framing psychiatry's position on ECT are themselves the arch capitalists who receive the primary benefit . . . the treatment is buoyed up by shoddy research and research flagrantly misrepresented . . . after four weeks, this brain-damaging treatment is no more effective than placebo . . . people . . . are being brain-damaged for nothing . . . The most pervasive themes . . . are: memory loss; cognitive impairment; loss of skills, prospects, ability to function, connection itself, with diminishment of the person emerging as an overarching theme. More psychological themes include: trauma, torture, and punishment. Control is of the essence. ECT . . . should not be paid for by our ministries of health, nor should it be offered by medical practitioners . . . [ECT] should be phased out. (p. 224)

Although no province, state, or country has officially banned ECT, there is worldwide resistance: The first International Day of Protest Against Electroshock, organized by three shock survivors, was held on May 16, 2015, in 28 cities in 6 or more countries including the United States, Canada, United Kingdom, New Zealand, Scotland, Ireland, Uruguay, and Chile.

The antishock movement is obviously a major priority action in the antipsychiatry movement, which, hopefully, will spread globally as Burstow and other activists including myself advocate. If you're a psychiatric survivor, activist, supporter, or ally, Burstow urges you to ask yourself these three key questions:

1. If successful, will the actions or campaigns that we are contemplating move us closer to the long-range goal of psychiatry abolition?

2. Are they likely to avoid improving or giving added legitimacy to the current system?

3. Do they avoid "widening" psychiatry's net? (p. 258)

Thanks to Bonnie Burstow, this book moves us closer to the day when there will be no medical model of "mental illness," no electroshock, no psychiatry, but Eutopia-a world based on mutual caring, emotional and social support, empathy, respect for our human rights, and humanity.

AuthorAffiliation

Don Weitz

Toronto, Ontario, Canada

Word count: 2638

Copyright Springer Publishing Company 2015

Critical Mental Health Nurse's Network Review

Bonnie Burstow Book Review

The following post is a book review by Jonathan Gadsby. If you would like to review a book or write a response to a book, please let us know. We have a list of great books to recommend, or perhaps you have one that you want to introduce to us.

Our list of books and reviews/responses is eventually going to become part of a project that will follow from the conference on the 9th of September. We would like to build a section on this website that students, tutors, practicing nurses and others can turn to for critical reading: books, articles, links, videos etc, especially critical writing about nursing.

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Bonnie Burstow’s Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting (Palgrave Macmillan, April 2015), is a significant addition to literature surrounding the evidence and practices of psychiatry in the 21st Century. An ‘Institutional Ethnography’, the nine chapters cover the history and culture of psychiatry, the evidence for psychiatric treatments, the cultures of the different mental health professionals, the formation and logic of the DSM and diagnosis, extensive discussion about the research, dissemination and actions of various psychiatric medications and ECT. The text is laced with feminist perspectives and survivor experiences. It is set in North America, but it is clear in the text just how strikingly similar the issues frequently are to the mental health scene in the UK.

This is not a book which picks apart aspects of mental health provision and makes suggestions for improvement. This is a book which describes psychiatry as a consequence of the state and a society driven by our fears, power and oppression, by the subjugation of women, non-whites, the rejections of all kinds of difference, the power of capital and machineries of misinformation which drench us in myths about progress. For Burstow, psychiatry cannot be understood as a branch of medicine or as any kind of science. She does not argue, as others have, that it is in need of a ‘paradigm shift’. Drawing on the influences of Thomas Szasz, RD Laing, Michel Foucault, Peter Breggin, Irving Goffman, David Healy and Robert Whitaker, this heavily referenced book is disturbing, personal and outrageous:

…what does “competence” even mean in a system such as this? How can we speak of competence when the entire industry is in the business of creating diseases and imbalance? Indeed, would anyone even be better off with a technically competent psychiatrist over a technically incompetent one? (p11)

What is new?

Some readers may feel that there is not very much here that is new, even while perhaps admiring the writing. Perhaps it is a little disingenuous to complain of this, for it is very clear that psychiatry, her subject, has been repeating old and discredited arguments for a long time. For me, there were several aspects which are, if not exactly new, then less familiar or which contained a fresh angle.

I had read before that psychiatry in the 20th Century was more widely interested with eugenics than might be generally known. Under Burstow, psychiatry and eugenics are long-time associates, and notions of heredity which pervade our thinking today originate there (p50). Psychiatry is described not as the unfortunate profession that was caught up in the fascist dogma of Nazism, but as the true architects of the Holocaust (p48), and neither was their influence limited to Germany, with concepts of degeneration and sterilisation widespread, especially in the USA. Burstow sees this not as a dark moment in psychiatry’s history, but intrinsic to the logic of distress attributed to biological origins:

Nazi Germany, according to its own postulates, was biocracy…. Psychiatry is in its own right a biocracy complete with incarceral capacities and police powers. In both instances, ruling is predicated on biological differences – real or imaginary. Indeed, what psychiatry is doing… is attributing physical difference to one segment of the population, then interpreting that difference as a mark of inferiority, warranting correction. Such a construction, I would argue, is itself a close relative of racism and indeed of all oppressions which locate inferiority in the body of “the other” (p71).

Also of great interest to me, as a nurse, was Burstow’s account of the ways in which psychiatry has been part of the disempowering and invisibilising of women’s knowledge (p31). From witches (whose main crime was the mixing of potions, more than ironic in the light of the chapter on psychopharmacology) to women healers, counsellors, midwives and abortionists, psychiatry is implicated as a key part of the framing of women’s knowledge as madness, disqualifying women from working with ‘the mad’ and the subsequent bringing of women to heel by men as ‘psychiatric nurses’, the ‘serviceable underling’ (p159). Burstow also critiques the professionalisation of mental health in ways which may strike a chord with many nurses, firstly as a means of marginalising competitors, and it additionally

“…cuts the professional off from authentic knowing and relating. It at once distances the professional from the “othered” person, nullifies the humanity of both, and subverts understanding, turning “help” into mini tasks, in which one can have “competencies” (p164).

However, it was in reading Burstow’s analysis of her interviews with psychiatrists that I felt most convicted as a nurse. That psychiatrists today are found with the same self-serving stories of being on the cusp of a new scientific and humanitarian age as they have repeated for the last two centuries is seen as comical (were it not for the power wielded by these credulous hopefuls) (p152). However, at that moment I saw the nursing story, working to change the system from within, a story that I have allowed myself to be recruited into, and I confess I still do not know what to do with that realisation. Burstow concludes that often well-meaning people are perpetuating the stories they need to hide their violence, and that their doing so amounts to “bad faith” (164). Not much middle ground is left.

Burstow’s examination of the DSM (referred to in her Institutional Ethnography as a ‘boss text’) is a particularly memorable chapter (p73 – 100), and while I have read arguments about validity and reliability many times, there did seem to be something incisive here in that Burstow argues that the purpose of the DSM is to couch reliability as validity (giving an analogy about identifying Martians!) (p78). Additionally, the chapter which concerns research and ‘evidence’ is essential reading, frightening though it is. While Burstow’s position appears extreme, Peter Gøtzsche of the Cochrane Collaboration has been producing similar analyses.

Are there limitations?

This book might be said to share (in parts) a problem with some of Robert Whitaker’s writing. Both writers refuse the simplistic manner in which psychiatry may paint experiences as secondary to biology, a simple arrow of causation from brain to person, and in doing so they stand on very established ground. However, when describing the damage caused by psychiatric drugs, they seem much happier to then re-explain experience as secondary to this damage, without the non-reductionist understandings for which they convincingly argued minutes before. That said, the discussion of the damage caused by psychiatric drugs makes for alarming reading, and, although I am no neuroscientist, does tally very well with experiences I have witnessed first hand (and with the work of Joanna Moncrieff, for example).

Trouble

Realisations I do not know what to do with, an approach which views psychiatry as part of state power and the common human practice of ‘othering’, dramatically argued chapters about the illegitimacy and corruption of psychiatric treatments and their deliberately damaging effects: one can see that to read this book is to be caught in a meta-narrative of urgent and global consequences, of moral polarisation and imperative. It is a book written in such a way as to produce two possible outcomes – to create revolution or to be ignored. Therein lies its great difficulty, and depending on what you feel about psychiatry – perhaps what you already feel before you pick the book up – you will likely either see the two options as a problem which is located in Burstow’s head (leading to an dismissal of the text, which is uncomfortable given her credentials and the highly referenced and logically-argued nature of much of it), or a problem located in psychiatry and society (leading to the sense of great unrest and urgency she would endorse). As such, one could argue that Burstow has very faithfully presented the world (and critical mental health discourse) as it is.

This problem is crystallised in the final chapter, entitled Dusting Ourselves Off and Starting Anew. If one views the problem of psychiatry as being part of a grand narrative about power, if the problem is on a global scale, then the solutions one has to propose must be too. The result is an enormously idealistic closing chapter, and, just as before, depending on your point of view you may see it as essential, brave and perhaps even prophetic, or else naive, opinionated and utopian. You may feel that in widening the discussion to war, gender inequality and the environment Burstow is going ‘off-topic’, or else you may feel that she is finally getting the the heart of the matter. With subheadings such as Daring to Dream and A Better World, I would imagine that Burstow would be aware of this, saying that it is a matter for professional to “decide whose side they are on” (262). There are some sections on trauma I will certainly return to. My own feeling is that your point of view is likely to be shaped by your experience of power: if you have it, it is generally hard to see what all the fuss is about. It would be wrong to conclude that this book is somehow all just a matter of strong opinion to either like or dislike. The mainstream and more accepted face of mental health services is obviously no less caught in a narrative: one which raises certain ideas to high prominence while sweeping huge problems (bad science, corruption, discrimination, harm, history) under the carpet. Those who reject the central arguments of this book will probably find it very difficult to explain why. And that suggests that it is crucial reading.

Original available at: http://criticalmhnursing.org/2015/07/

Review from Don Weitz in Ethical Human Psychology and Psychiatry, Vol 17, No 1

Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. Bonnie Burstow. London, United Kingdom: Palgrave Macmillan, 2015, 316 pp., $40.00 (paperback) $95.00 (hardcover).

This book is arguably the most comprehensive and brilliant critique of psychiatry that I've ever read; it's a devastating expose of psychiatry's discredited medical model and institutional psychiatry, "a regime of ruling." Bonnie Burstow's book is absolutely awesome in its numerous, thoroughly researched facts and original insights and scholarship frequently voiced with passion. Burstow uses the research analytic tool of institutional ethnography-"ruling happens through texts, particularly through the activation of texts" (p. 18). With this powerful intellectual probe, she deconstructs "boss texts" and takes us on an incredible journey into psychiatry, its alarming methods of social control, its intrusive brain-damaging drugs and electroshock. Burstow ends this awesome work in the spirit of hope and humanity she calls "Eutopia," a vision of a better world of compassion, empathy, mutual caring, respect for freedom and human rights. 

She begins with a short and concise history of psychiatry featuring mad doctors and "alienists" (an apt word) during the 18th century, including Philippe Pinel who unchained poor people with mental illness in a Paris asylum but instituted a reign of terror of close surveillance and control. In the 19th century, there's Benjamin Rush, the notorious "father of American psychiatry" whose face appears on the American Psychiatric Association's logo; he invented the traumatic "tranquilizer chair" and advocated fear as therapeutic; he also labeled black slaves with the disease of "drapetomania," running away to be free; he also committed his son to an insane asylum. The gentler "moral treatment/moral management" of country retreats in the late 18th and early 19th centuries soon died; by the late 19th and early 20th century, it was replaced with eugenics/genetics-based, physically intrusive biological psychiatry, which unfortunately dominates today. This is a small but telling fragment of psychiatry's dark history of social control, medical fraud, coercion, and violence.
Burstow asserts that two fundamental principles underlie psychiatry and the book: parens patriae and police powers. Parens patriae (literally "father of the country") refers to power of the state to control, imprison, and forcibly treat citizens; police powers are mainly expressed as coercion, arrest, and use of force. Psychiatry, Burstow asserts, is essentially a regime of ruling; however, given psychiatry's hegemonic social control, the terms psychiatric dictatorship and psychiatric police state seem more appropriate.

In Chapter 4 ("Probing the Boss Text: DSM-What? Whither? How? Which?"), Burstow brilliantly analyzes the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry's bible of fraudulent diseases. Unlike medical diagnoses, the approximately 350 diagnostic labels in DSM-5 (the current edition) are not only subjective and unscientific but also frequently lead to serious life-changing consequences such as loss of freedom (involuntary commitment), psychiatric drugging, and/or electroshock (electroconvulsive therapy [ECT]). DSM labels, Burstow asserts, serve no medical or scientific purpose, instead they routinely marginalize and stigmatize. Burstow succinctly summarizes major problems of the DSM, "subjectivity . . . masquerading as objectivity . . . nothing less than the essence of who the person is . . . constitutes a disorder" (pp. 94-95). She calls this activating text a "patient-processing system," denounces it as having absolutely no scientific validity or reliability; like the late psychiatrist Thomas Szasz and other dissident health professionals, Burstow correctly states there is "no mental illness" because there is no biological or medical evidence of cellular disease in anybody labeled mentally ill. With surgical precision, she exposes the fraudulent nature of DSM diagnoses while examining constructs such as "personality disorder," "oppositional defiant disorder," "schizophrenia," and "attention deficit/hyperactivity disorder (ADHD)," all allegedly types of "brain disease" caused by the discredited "chemical imbalance" theory. What's going on here is irrationally medicalizing nonconformist behavior, in fact virtually any intense emotional state-for example, sadness or grief labeled "depression," joy labeled "hypomania," and most everyday problems as "mental disorders." The DSM is the modern equivalent of the Inquisition's Malleus Maleficarum, a medieval boss text of written instructions ("criteria" or "symptoms") designed to identify and demonize heretics and witches-today's "mental patients." In short, "human existence itself [is] . . . theorized as . . . a disorder" (pp. 89-90); "problems are located exclusively within the individual . . . something that conflicts with Aboriginal experience, not to mention that of most of the world" (p. 92). This is not medical diagnosis or "medical science," it's psychiatry-and-state-sponsored quackery.
Another clear and important message is "psychiatry is an agent of the state." In this connection, Burstow examines relevant sections of Ontario's Mental Health Act (MHA; Chapter 5, "The Beast/Inside the Belly of the Beast: Pinioned by Paper"). Like virtually all mental health laws and regulations, the MHA legitimizes preventive detention as involuntary committal (incarcerating citizens without charge and public hearing or trial); it also falsely assumes that psychiatrists can predict dangerousness. As an example, Burstow cites these sweeping and vague criteria for involuntary committal:

The patient is suffering from mental disorder of a nature or quality that likely will result in:
(i) Serious bodily harm to the patient,
(ii) Serious bodily harm to another person, or
(iii) Serious physical impairment of the patient unless the patient remains in the custody of a psychiatric facility. (p. 107)

The term mental disorder is not specifically defined here or anywhere else in the act. Also, the term likely will result is a guesstimate, not medical evidence or scientific fact, because psychiatrists admit they cannot predict dangerousness; the term serious physical impairment is obviously, if not deliberately, vague and open to multiple interpretations. As ruling words, these criteria make it very easy for psychiatrists to label and lock up and chemically restrain (forcibly drug) innocent citizens for at least 72 hours under the "Observation and Assessment" provision in Form 1. The incarceration and forced drugging of Irit Shimrat, a close friend, courageous survivor, and author, is very relevant; her story is a frightening object lesson in psychiatric-and-state-sponsored coercion and violence (pp. 123-124). Compounding this injustice, during the initial "period of observation and assessment," the person cannot appeal or launch any legal action. Even more alarming, Burstow points out that people can also be involuntarily committed (lose their freedom) if they refuse to "take their meds," or if they've "previously received treatment or from a mental disorder . . . and likely to suffer substantial mental or physical deterioration or serious physical impairment" (p. 109). Again, this major term is not defined or explained. Equally alarming, the MHA greatly expands police powers such as authorizing police officers in Ontario the power to diagnose mental disorder, predict dangerousness, arrest, and forcibly transport citizens to psychiatric facilities for psychiatric examination mainly based on subjective belief:

A police officer has reasonable and probable grounds to believe that a person is acting or has acted in a disorderly manner and has reasonable cause to believe that the person,
(a) Has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;
(b) Has behaved or is behaving violently toward another person and has caused or is causing another person to fear bodily harm from him or her; or
(c) Is showing a lack of competence to take care of himself or herself, and in addition the police officer that the person is apparently suffering from a mental disorder of a nature or quality that will likely result in,
(d) Serious bodily harm to the person,
(e) Serious bodily harm to another, or
(f) Serious physical impairment of the person.

Burstow comments, " . . . evidence that officials are permitted to use in making their assessments includes not simply what they directly observe but also what is relayed by others. The 'mentally ill person' becomes 'an easy target.' People can be committed against their will simply because they are not taking their meds." Many survivors stop or try to stop taking antidepressants and/or neuroleptics (antipsychotics) for good reason-they can't tolerate the incredible suffering and disability the drugs cause (p. 110).

Once the person ends up in a psychiatric hospital or mental health center, he or she is subjected to more violence, what Burstow calls "cosmeticized violence . . . students are socialized to give and force damaging treatments on people". In the chapter "The Psychiatric Team," psychiatric and nursing staff violence inherent in physical restraints, forced drugging, and "seclusion" (solitary confinement), for example, is rationalized as self-defence from the perceived or imagined violence of patients "in need of control." In this environment ruled by a hierarchy of psychiatrists, psychologists, nurses, and social workers, violence serves a double purpose-control of patients and enforcement of unity among team members. In this controlled and controlling environment, whistleblowers are nonexistent; team solidarity trumps care, compassion, and empathy.
"Marching to 'Pharmageddon': Polypharmacy Unmasked" (Chapter 7) is an important consciousness-raising object lesson on psychiatric drugs as a major method of social control. The brain-damaging effects of psychiatry's "safe and effective" neuroleptics (antipsychotics)-for example, blunting of emotions, apathy, indifference, cognitive impairment; so are akathisia, tardive dyskinesia, neuroleptic malignant syndrome, and parkinsonism, all are clinical indications of brain damage sanitized as "side effects" of psychiatry's "safe and effective medication." Burstow draws heavily on the consciousnessraising critiques of dissident psychiatrist Peter Breggin, investigative journalist Robert Whitaker, and other independent researchers, as well as her own professional knowledge and experience. Although not a medical doctor, Burstow clearly and critically explains how these drugs, particularly the "atypical" neuroleptics such as Risperdal, Zyprexa, and Abilify that impact several parts of the brain; they seriously disrupt the neurotransmitter dopamine in the mesocortical and mesolimbic systems, invariably causing brain damage or chemical lobotomy. The antidepressants have similar if not more serious brain-damaging effects in addition to causing suicidal ideas, suicide attempts, mania, and sudden violence. The biological psychiatrists, Burstow asserts, falsely claim "chemical imbalance" or lack of dopamine in the brain as the major cause of schizophrenia, for example; psychiatrists, medical doctors, and researchers, largely funded by the drug companies (Big Pharma) continue ignoring the fact that psychiatric drugs cause this chemical imbalance and brain damage, including the tragic and disabling neurological disorders-an admission they're afraid to acknowledge. A person with a previous psychiatric history can be kept on psychiatric drugs virtually indefinitely, thanks to a community treatment order, another boss text that authorizes doctors, not just psychiatrists, to prescribe psychiatric drugs for years or indefinitely to patients after they're released to the community (see Tranquil Prisons by Erick Fabris). Under this draconian mental health law, refusal to "take their meds" can result in people being committed for longer periods. The transnational drug companies also come in for well-deserved criticism for their unscientific research and unethical marketing practices, including mislabeling and hiding many health-threatening effects of psychiatric drugs during clinical trials, major findings are often kept secret. Also, government regulators such as the Food and Drug Administration (FDA) in the United States and Health Canada are shown to be frequently incompetent and complicit in failing to fully warn and protect the public about high-risk drugs.

Burstow is at her most critical in powerfully exposing and denouncing "Electroshock" (ECT), arguably psychiatry's most destructive procedure today, one that many shock survivors and activists have been protesting against for almost 40 years and want banned (Chapter 8). Contrary to popular belief following the film One Flew Over the Cuckoo's Nest, ECT never stopped and never banned but has increased worldwide. Burstow accurately and concisely describes the ECT procedure involving sedative, muscle paralyzer ("muscle relaxant"), oxygen, and electricity; 1501 V are delivered from a shock machine to electrodes placed on one side (unilateral) or both sides (bilateral) of the brain. ECT always causes a grand mal seizure-dishonestly called therapeutic by shock promoters Richard Abrams, Max Fink, the American Psychiatric Association, and Canadian Psychiatric Association. Also, every ECT causes an immediate convulsion, coma, memory loss, and brain damage. Burstow bluntly and concisely comments, Iatrogenically created dysfunction, Diminished capacity. Lobotomy-like unawareness. Anosognosia-the cognitive impairment that involves inability recognize that one is impaired Compliance itself. Euphoria caused by brain damage . . . after four weeks, this brain-damaging treatment is no more effective than placebo . . . people . . . are being brain-damaged for nothing . . . The most pervasive themes . . . are: memory loss; cognitive impairment; loss of skills, prospects, ability to function, connections itself, with diminishment of the person emerging as an overarching theme. (pp. 215, 224)

The American Psychiatric Association's promotional mantra that ECT is "safe and effective treatment" is directly challenged by several scientific studies that Burstow summarizes. For example, she succinctly explains the significance of Harold Sackeim's landmark comprehensive 2007 study in which he conclusively proves the brain-damaging and memory-destroying effects of electroshock-regardless of type or mode of ECT, placement of electrodes, age, and gender; as prime targets, women and the elderly suffer the greatest damage, reflecting sexist and ageist biases in ECT (pp. 212-213). Electroshock's many devastating and tragic effects come to life with excerpts of Burstow's interviews with several Canadian shock survivors and some of their personal testimony at the 2005 Enquiry into Psychiatry public hearings in Toronto. The statements by Connie, Wendy, and "C's" story are particularly memorable and riveting; they courageously speak truth to power (pp. 216-222).

As organizational-systemic analysis, Burstow's graphic illustrations of the "The ECT Empire" (p. 204) and "Rule by ECT Scholar/Capitalists" (p. 208) are original, accurate, and chilling in their details. They clearly show the interconnections and conflicts of interest among shock promoters such as Richard Abrams, Max Fink, and Richard Weiner with the American Psychiatric Association's task force reports, close links to journals, textbooks, shock machine manufacturers (e.g., somatics owned by proshock psychiatrist Richard Abrams), hospitals, and government regulators such as the FDA and Health Canada. Near the end of this chapter, these conclusions are worth quoting and remembering: "People's lives are essentially obliterated-erased" (p. 217).
The authorities most influential in framing psychiatry's position on ECT are themselves the arch capitalists who receive the primary benefit . . . the treatment is buoyed up by shoddy research and research flagrantly misrepresented . . . after four weeks, this brain-damaging treatment is no more effective than placebo . . . people . . . are being brain-damaged for nothing . . . The most pervasive themes . . . are: memory loss; cognitive impairment; loss of skills, prospects, ability to function, connection itself, with diminishment of the person emerging as an overarching theme. More psychological themes include: trauma, torture, and punishment. Control is of the essence. ECT . . . should not be paid for by our ministries of health, nor should it be offered by medical practitioners . . . [ECT] should be phased out. (p. 224)

Although no province, state, or country has officially banned ECT, there is worldwide resistance: The first International Day of Protest Against Electroshock, organized by three shock survivors, was held on May 16, 2015, in 28 cities in 6 or more countries including the United States, Canada, United Kingdom, New Zealand, Scotland, Ireland, Uruguay, and Chile.

The antishock movement is obviously a major priority action in the antipsychiatry movement, which, hopefully, will spread globally as Burstow and other activists including myself advocate. If you're a psychiatric survivor, activist, supporter, or ally, Burstow urges you to ask yourself these three key questions:

1. If successful, will the actions or campaigns that we are contemplating move us closer to the long-range goal of psychiatry abolition?
2. Are they likely to avoid improving or giving added legitimacy to the current system?
3. Do they avoid "widening" psychiatry's net? (p. 258)

Thanks to Bonnie Burstow, this book moves us closer to the day when there will be no medical model of "mental illness," no electroshock, no psychiatry, but Eutopia-a world based on mutual caring, emotional and social support, empathy, respect for our human rights, and humanity.

 Don Weitz
Toronto, Ontario

Psychiatry and the Business of Madness Book Review

Psychiatry and the Business of Madness: A Book Review

by Simon Adams, RN, PhD

Author: Bonnie Burstow
Publisher: Palgrave MacMillan

ISBN: 978-1-137-50384-8 (Paperback $40)
ISBN: 978-1-137-50383-1 (Hardcover $95)

I picked up this book with the intent to see how the mental health professional is handled, particularly, how nursing is theorized. As an academic nurse and professional participant in the research, I have a particular engagement with this book. Having long grappled with the effects of psychoactive drugs on the human brain, reading Burstow’s psychopharmacology analysis concretized this for me. While she is not a medical doctor, her analysis made accessible the chemistry of the drugs and its impact on the body. The book also gave me a solid look into where nursing stands in relation to the larger establishment of psychiatry. As an institutional ethnographer, I am delighted with this use of institutional ethnography. What is particularly special about this book is its very thorough analysis of the institution. 

In her rather troubling institutional analysis, Burstow unveils the ethically dubious relations of power and the discourses that establish and maintain modern day psychiatry. She begins with a disturbing, visceral account in the everyday world of the psychiatrized and methodically proceeds to trace the various intricate political and historical workings of the regime. Leaving no stone unturned, the author sketches distant and recent history, dissects discourses, examines texts, interrogates practices, maps out vested interests, relationships, politics, and processes. Advancing a sobering (and at times, bloodcurdling) analysis, she implicates history and brings attention to the disconcerting philosophical, political, and moral underpinnings of the psychiatric regime. Burstow carries out a carefully-investigated institutional ethnography within which she weaves a dynamic critical discourse analysis. She does this with impeccable logic.

The book, an original contribution to the critical and abolitionist literature, is unique in the following ways: It gives an inside look at the workings of the Ontario Consent and Capacity Board, advances an analysis of how psychiatry comes together as a multi-institutional system, and offers a real and everyday vision for a better world.

The mental health industry is exposed as a system that is fitted together by a number of sub-institutions: psychopharmacology, the research industry, the State, and the hospital, to name a few. As its textual locus of control, psychiatry, and by extension, the mental health team draws on the DSM. On the DSM, Burstow writes that it is “conceptually, phenomenologically, and otherwise flawed,” its categories have “no relationship to validity,” its diagnoses have no biological basis, and its criteria sets “are blatantly sexist, racist, classist, and transphobic.” This, she roots in an analysis of the text – the “boss text” – as a presiding “ruling” mechanism whose textual logic eclipses and overrides that of the humanistic and the compassionate. A formidable and cogent ethnography!

The author establishes that “psychiatry’s basic tenets are insupportable, that no biological basis has been established for any mental illness, that the claims of chemical imbalance lack foundation, the profession has no ability to predict dangerousness.” She probes the profession and its practices, paving the way for a compelling analysis of psychiatric drugs, advancing that they themselves lead to chemical imbalances and irreversible brain damage. To that respect, she writes: “no medical credibility can be attached to a substance that is not medical, that addresses nothing medical, that gives rise to medical disorders, and whose modus operandi is dysfunction and damage.”

In chapter five, what is arguably her most powerful chapter – and they are all indeed powerful – Burstow demonstrates how the institution comes together, both a unique and a compelling contribution. Unique because no other scholar in the area has carried out an investigation on this level, and compelling because of the utter palpability of the evidence she presents to secure this institutional picture. The author demonstrates the functioning of psychiatry as an “extensive network of laws, forms, organizations, agents, procedures, all of a transcarceral bent, all of it circular, all of it facilitating psychiatric rule.” She takes us through the never-before-investigated Ontario Consent and Capacity Board hearings, exposing their institutional and discursive smokescreens. She transplants the reader alongside her while observing psychiatry’s “processing” of the patient, noting that “aspects of the system purportedly designed to protect ‘patients’ from ‘psychiatric excesses’ – the Consent and Capacity board, for example – are predicated on and overwhelmingly reinforce psychiatry.”

It is in Burstow’s micro and macro investigative style that the reader eventually finds herself unable to hold on to psychiatry as a helping profession or as a legitimate medical entity altogether. Without the reader needing to look further, psychiatry is left to crumble in the face of Burstow’s commanding historical archeology, her institutional and discourse analyses, and her methodical step-by-step look at the system from within and from without.

With her final chapter, which is notably the most original contribution to the literature, Burstow challenges the boundaries of our thinking. She offers a beginning to an alternate, psychiatry-free world, one rooted in community and individual autonomy. And still, in this “eutopia,” she does not ignore the possibility of violence and interpersonal conflict, only here, they are convincingly theorized as a rare occurrence. She offers what no other scholar in this area has: Real and everyday interpersonal and relational case scenarios, complete with possibilities of what to do and how to proceed.

While holding on to the complexities, the author writes with exceptional clarity. The book, though a multi-decade scholarly investigation that dialogues with professionals and other scholars, is more importantly an accessible, informative, and sensitive piece of work that speaks to the everyday person. Burstow addresses doctors, nurses, social workers, psychologists, researchers, legislators, survivors, parents, friends, and community members. She navigates such complex and multilayered discussions beautifully.

This book is long-coming. It creates a rift in our thinking. It begins a commanding counter-narrative to the psychiatric status quo. A daring piece of work that is both unsettling and necessary and an enriching and an essential possibility to social work, nursing, psychology, and medical curricula. Psychiatry and the Business of Madness marks a long-awaited radical trajectory change in the direction in which the world ought to go.

In ending, do yourself a favour and pick up this remarkable book. If you are like me, besides that you will learn a great deal, like with so many other of the classic in the field – and yes, I am predicting that it will quickly become a classic – you will not be able to put it down. 

See more at: EmpathicTherapy.org

Interview with Dr. Burstow on Rabble.ca

Probing psychiatry and the business of madness

What kind of society do we need to create so that people will thrive rather than feel alienated?

BY 

LAUREN SPRING

 | JULY 30, 2015

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Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting

by Bonnie Burstow

 

(Palgrave Macmillan, 

2015; 

$40.00)

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A revolutionary new book on psychiatry, Psychiatry and the Business of Madness: An Ethical And Epistemological Accounting by Dr. Bonnie Burstow, was recently released by Palgrave Macmillan and has already drawn major conclusions and had huge societal implications.

The book deconstructs psychiatric discourse and practice and challenges the reader with such conclusions as: There is no credible basis for a single "mental disorder" and the drugs prescribed do not correct but create chemical imbalances.

Burstow challenges the reader to examine how society addresses certain problems and perhaps if we need to abandon psychiatry and rebuild lives together.

Lauren Spring, art-based trauma specialist and a doctoral student, sat down with the Burstow to discuss her latest book and the conclusions and implications it has achieved.

This is an abbreviated version of the interview.

Why do you feel this book is important for people to read now?

To be clear, the problems illuminated didn't just emerge. While I realize that this is contrary to people's image of psychiatry as a necessary service, as the book demonstrates, psychiatry can be roughly characterized as a regime of disinformation, intrusion, damage, and control -- in other words, there is a problem here; and the problem has been serious a long time. People are being treated as if their ways of being in the world, admittedly often troubled ways, are medical disorders, when in point of fact, they are not.

In the process, people are being brain-damaged and their lives substantially reduced. That said, what makes this particularly urgent is that psychiatry is a growth industry and so even more people are being damaged and diminished.

Bearing that in mind, who do you think should read this book? Who did you write it for?

I wrote it for psychiatric survivors, for their families, for professionals, for scholars. But first and foremost, I wrote it for members of the general public. This is our society: We have given immense authority over people deemed mad to this industry which is, in essence, declaring ever more and more people crazy, which is not solving but both creating and exacerbating people's problems in living. It's time for us to rethink and rescind that authority.

One of chapters that stuck with me most was that one about the health-care team, and this idea you bring up of professionalization. What I thought was very interesting was that you weren't demonizing the individual practitioners, but placing them in the context of this larger system. Could you speak to that?

The purpose of mental health professionalization is to serve the professionals; the purpose of the related industries to serve the industry -- and individual practitioners-in-the-making are partially unwittingly sucked into this.

To put this another way, people go into these different disciplines, in many cases, out of a heartfelt desire to help. And slowly but surely, they get socialized into modes of thinking that have them acting in these destructive ways.

In concert with this, just as professionals control the so-called mentally ill, they are themselves controlled. In this regard, I interviewed a large number of people from different disciplines that work in "psychiatric institutions," members of "the mental health team," as it's called. And what I discovered is that there's a party line, and people are more or less forced to toe that line. A nurse, for example, could not just ask other team members, "Why are we immediately turning to electroshock with this patient?" Indeed, one of the nurses interviewed in my research says, she was called on the carpet just for asking that question.

You give a very comprehensive history of the origins of psychiatry. And of course, historically, women were often psychiatrized for behaving in certain ways…or just existing in the world, right?

Women were psychiatrized either for stereotypically being women, or for veering too far from the stereotypes. Either one. As for what's happening now, today, there is no question that there are stereotypical women's diseases -- e.g., "borderline personality disorder" -- and there is no question that women are way more likely to end up being given a "disorder" than a man, also to be given more serious ones. That's true, I would add, of oppressed people in general. Of racialized people, poor people, trans people, etcetera. That noted, there is also a degree to which psychiatry is nonetheless an equal opportunity oppressor, in the sense that it is quite happy to psychiatrize anyone. With psychiatry's interest in continual expansion, that's the new reality that we are facing -- everybody is in jeopardy.

What role do you see the pharmaceutical industry playing in modern day psychiatry?

The pharmaceutical industry, for all intents and purposes, is modern day psychiatry -- all else are "add-ons." What's important to understand here is that in 1970s psychiatry found itself in danger of disappearing for non-medical professionals were frankly better at helping. Its solution was to hyper-medicalize -- that is, to create more and more the false appearance that what it was doing was medical.

In this drive to medicalize, the one thing that doctors are most noted for -- giving drugs -- became focal, for emphasizing it would really make their work look medical. Enter the foundationless claim of chemical imbalances and the drug push. Now we have an unholy alliance between psychiatry and the pharmaceutical companies, whose ultimate interest of course, is profit.

You refer in the book to the DSM [Diagnostic and Statistical Manual of Mental Disorders] as a "boss text." Could you elaborate?

As a central text, it sets practitioners up to look at distressed and/or distressing people in certain ways. So, if they go into a psychiatric interview, they're going to be honing on questions that follow the logic of the DSM, or to use their vocabulary, the "symptoms" for any given "disease" they're considering.

In the process it rips people out of their lives. And so now there's no explanation for the things people do, no way to see their words or actions as meaningful because the context has been removed.

In essence, the DSM decontextualizes people's problems, then re-contextualizes them in terms of an invented concept called a "disorder."

Let me give you an example. "Selective Mutism" is a diagnosis given to people who elect not to speak in certain situations. So, if I were a non-psychiatrist -- that is, your average thinking person who is trying to get an handle on what's going on with somebody -- I would try to figure out what situations they aren't speaking in, try to find out if there's some kind of common denominator, to ascertain whether there's something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example, a person of colour going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, "Selective Mutism" is a discrete disease.

So, according to psychiatry, what causes these "symptoms" of not speaking? Well, "Selective Mutism," does. Note the circularity. That's what all the "mental disorders" are like: No explanatory value whatever, just circularity -- and yet they have authority in law. And as such, they authorize what gets done to people.

One of the things so remarkable about this book is you're helping us understand through history. Why did you think it important to open the book with a history of psychiatry?

If we do not know where something comes from, we do not know where we are. So I wanted readers to see: How did decisions really get made? What was really behind them? Once you get through the history chapters, you have a sense of the territory.

Absolutely. I learned a lot from reading those chapters. To skip to the end, your final chapter -- and it's beautifully written and really sparks the imagination -- is about a world without psychiatry. Could you discuss that?

Questions that we need to grapple with and that are posed in this chapter are: What kind of society do we need to create so that people will thrive rather than feel alienated? How do we reconstitute society so that everyone helps everyone else and so that we deal with problems together rather than targeting individuals and having those targeted folk consigned to experts? In essence, how do we live together in kinder, more accepting, more participatory, and more egalitarian ways?

One final question: How do we stop seeing psychiatrists as heroes?

By being honest about the invalidity and the harm being done; by looking at the diminishment of community that happens when we hand the power to govern ourselves over to experts; by once again daring to dream. If we start doing that, might we not then individually and collectively be able to bring ourselves to admit that the rise of psychiatry was a colossal misstep?

For details about the research underlying this book, see http://bizomadness.blogspot.ca/

Dr. Bonnie Burstow is a faculty member at Ontario Institute for Studies in Education, a philosopher, a social theorist, a feminist therapist, an author, and a long time anti-psychiatry theorist and activist. Her books include: Psychiatry and the Business of Madness, Radical Feminist Therapy and The House on Lippincott, as well as two anthologies of which she is first editor: Shrink-Resistant and Psychiatry Disrupted.

Lauren Spring is a doctoral student at Ontario Institute for Studies in Education, where she is conducting extensive research into military trauma, specifically focused on the Canadian military. She is also an actor, a theatre director, a critic of psychiatry, and an art-informed researcher. 

(Original site: http://rabble.ca/books/reviews/2015/07/probing-psychiatry-and-business-madness?utm_content=buffer72dc0&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer)