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Antipsychiatric activism and feminism: the use of film and text to question biomedicine This article examines the relationships between antipsychiatric activism and feminism, paying particular attention to the civil liberties of consumers/survivors/expatients (c/s/x ANTIPSYCHIATRY individuals) in relation to mental health practices. It argues that a continually rigorous exploration of the complex (and at times uneasy) relationships between antipsychiatric activism, feminism and

Diane R Wiener mental health practice is necessary and useful for pursuing social justice by working toward the Assistant professor of social work diminishment of mental health inequalities. The article includes an overview of the ‘spectrum’ of Binghamton University antipsychiatric stances and a review of some of the literature covering the relationship between

Correspondence to: antipsychiatry and feminism, and uses cinematic and literary examples to highlight the complexity of Diane R Wiener Assistant professor of addressing issues like medication ‘compliance’ and ‘non-compliance’ among mental health users and social work Binghamton University consumers in biomedical contexts. School of and human development Division of social work PO Box 6000 Binghamton, NY 13902- 6000 USA e [email protected] he influence of the antipsychiatry stances, for a variety of purposes, and these labels are movement in the US and western Europe deployed by speakers and writers in ways that are – especially in the UK, whence several of sometimes coalitional and sometimes divisive. For the founders hailed and/or worked – is due example, on its website The Antipsychiatry Coalition Tin large part to the efforts of RD Laing employs the term ‘democratic’ to serve its potent Keywords: (1971), (1973; 1984; 1994; 2003), David politicised ends. The coalition describes itself online as antipsychiatry feminism Cooper (1970), and (1992; 1994; 1995; a: biomedicine 1999). (One should, of course, add the proviso that psychiatric survivors disability rights many of those associated with antipsychiatry did not or ‘… non-profit volunteer group consisting of people do not embrace the term antipsychiatry itself.) In the who feel we have been harmed by – and late 1960s and early to mid-1970s, these individuals of our supporters. We created this website to warn argued from a variety of political and theoretical you of the harm routinely inflicted on those who positions that psychiatry is a form of social control. receive psychiatric ‘treatment’ and to promote the Importantly, these thinkers promoted their critiques as democratic ideal of liberty for all law-abiding people practising and psychotherapists. Szasz that has been abandoned in the USA, Canada, and famously maintained that mental illness is a societal other supposedly democratic nations.’ ‘myth’ (Szasz, 1960), and indeed both he and Breggin (www.antipsychiatry.org accessed 1 July 2005) continue to speak publicly and write works on antipsychiatry (see www.szasz.com and In my view, any invocation of an antipsychiatric trend www.breggin.com). For these activists, psychiatric in the mid to late 20th century and since, and references medication and mental health treatment are to the perceived diminution, cessation, or shifts of such manipulative tools used skillfully by what Szasz (2003) a trend, cannot and should not be expected to describe calls the ‘pharmacracy’ of the nation state to dictate ‘antipsychiatry’ as a singular stance, because ideas and human behavior and to manage deviance. practices that may be understood to index an Various monikers – among them ‘liberal,’ antipsychiatric perspective are historically, culturally, ‘progressive,’ ‘feminist,’ ‘leftist,’ ‘Libertarian,’ and and personally situated, and include an enormous range ‘Marxist’ – are frequently tacked on to antipsychiatric of points of view. Put differently, what is constituted as

journal of public mental health 42 vol 4 • issue 3 © Pavilion Publishing (Brighton) Ltd Antipsychiatry activism and feminism: the use of film and text to question biomedicine

an antipsychiatric stance today might not have been by exploring the conceptual and political underpinnings considered an antipsychiatric stance in the past (and of various antipsychiatric positions, it is possible to vice versa, since definitions can obviously change arrive at a rich understanding of the far-reaching effects meaning over time): defining what constitutes an that biomedical approaches to mental illness can have antipsychiatric stance is always a matter of debate. A on both individuals and on society. It is my contention partial summary of what I see as a ‘spectrum’ of that textual and visual works provide us with contemporary antipsychiatric stances follows: particularly creative opportunities to explore both the practices and ideologies promulgated by biomedicine l a keen suspicion of psychiatry and ’s and the wide array of antipsychiatric responses to them. efficacy to properly treat symptoms and/or cure But before turning to cinematic and literary examples, experiences deemed to be or labeled as mental it is important to consider the intricate relationships illnesses that have existed and continue to exist between l a disbelief in or a refuting of a biological basis or antipsychiatry and feminism. cause for mental illnesses l an assertive quest for proof of the allegedly Antipsychiatry and feminism biological basis for mental illnesses Ussher (1991) and Showalter (1987) have discussed l a view – notably held by some medical and extensively the complicated relationship between psychological anthropologists – that sees mental antipsychiatry and feminism. Hubert (2002) and illnesses as social ills that are ‘culture bound Caminero-Santangelo (1998) have, in turn, differently ’ with attendant culturally and temporally elaborated Ussher’s and Showalter’s analyses in their specific meanings, ranging from acceptance to own works on ‘women’s madness narratives.’ Hubert stigmatization notes: l a statement that mental illnesses are more than merely culturally specific, or socially constructed, or ‘Showalter has criticised antipsychiatry on the basis not trans-historical, but are also partly or even of sexual bias. For all the “feminist” promise of entirely the fault of a toxic or ill society that Laing’s theories, she writes, “antipsychiatry had no produces these conditions among some of its coherent analysis to offer to women”. Moreover, members Showalter describes unethical forms of treatment. l an argument that psychiatric medications are niche- According to Showalter, David Cooper “advocates marketed and over-prescribed, in part to support an sex with patients”… [a] practice of sexual exploitative pharmaceutical and mental health exploitation.’ (Hubert, 2002) industry l a strong opinion that individuals should not be Similarly, Ussher (1991) powerfully remarks: forcibly committed, medicated, or otherwise treated against their will or without their expressed ‘The antipsychiatrists and dissenters were not the understanding and knights in shining armour they have sometimes l a contestation questioning the existence of mental been depicted as, ready to transform the institution illnesses into a haven, by breaking down the nosological l a belief that mental illnesses are the inventions of a battlements and spiriting the misdiagnosed to capitalist society for the purposes of state-sanctioned freedom. There are many weaknesses and social control and discriminatory enactments of limitations within their analysis… one major acceptable against those deemed mentally omission in their work is the analysis of the specific ill or otherwise deviant within that society. problems and oppression experienced by women. Gender, patriarchy and misogyny were not high on This diverse set of antipsychiatric platforms has the the agenda of the so-called radicals – if on their potential to teach us a great deal about public mental agenda at all. To read their work one would health and mental health practice today. Because some imagine that the mad person was gender-neutral, antipsychiatric activists directly challenge the common when we know that women make up a large presupposition that ‘mental illness’ is genetic or percentage of those who are positioned within the otherwise biological, taking seriously the critical value discourse of madness. For, since the Victorian era, of these politicised stances – especially when espoused madness has been synonymous with femininity, and by psychiatric survivors speaking on their own behalf women predominate in both the “official statistics” and on behalf of other consumers/survivors/expatients and popular discourse… It was the feminist critics (c/s/x) individuals – can help advance a deep inquiry who redressed the balance.’ into the implications that current practices of and ideologies around biomedicine have for public mental Although several feminist scholars have strongly health and for mental health practices. In other words, denounced antipsychiatry, it is important to recognise

journal of public mental health vol 4 • issue 3 43 © Pavilion Publishing (Brighton) Ltd Antipsychiatry activism and feminism: the use of film and text to question biomedicine

that, in many ways, antipsychiatry and feminism have the internet, in memoirs, and in autobiographical shared common goals. For example, Caminero- documentary film narratives), versus how those Santangelo addresses the point emphatically made by discourses and debates are presented in cinematic Chesler (1972) and Showalter (1987) that, for many images and written stories about the ‘mentally ill’ that feminists, ‘electroshock [is] inherently patriarchal’ are often made by non-psychiatric survivors. In the (Camino-Santangelo, 1998). Caminero-Santangelo remainder of this essay, I use three examples to elaborate also foregrounds Showalter’s acknowledgement of her on some of these points. ambivalent indebtedness to RD Laing’s politics: Showalter appreciates much of what he did, wrote, and Girl, Interrupted said, but has angry or mixed feelings about some of his In the film Girl, Interrupted (1999) there are both and Cooper’s claims and practices. For many years, negative and positive portrayals of medication usage, members of the feminist therapy movement have including scenes of patients ‘cheeking’ psychiatric criticised the problematic enactments of patriarchy that medication while in an asylum. In one scene, have unfortunately attended some forms of both protagonist Susanna (played by Winona Ryder) is given psychiatry and antipsychiatry. Feminist therapy a drug that makes her feel sick, dizzy, and out of control. practitioners have paid particular attention to redressing Her point of view in the film merges with the viewer’s in these problems by developing and advocating for an overtly nauseating way: the camera is used to put the specialised feminist psychotherapeutic practices, viewer in her shoes, as it were, and the experience community programmes and centres, clinics, and so on. shared is a vivid and negative one. In another scene, But feminism has not escaped criticism for some of Susanna’s fellow asylum inmate and buddy Lisa (played its own formulations of mental distress and madness. In by Angelina Jolie) teaches her to ‘cheek’ her medication Caminero-Santangelo’s aptly titled The Madwoman properly, and Susanna subsequently does so. While the Can't Speak: or Why is not Subversive, she mental health patients in the latter scene might be explains why she believes that some feminist theorists judged initially by some viewers as simply ‘non- are no better than some psychiatrists in the ways they compliant’, the portrayals made available by Girl, ‘other’ women who are labeled and/or who self-identify Interrupted instead code the patients as exerting agency as ‘mentally ill’. She finds this parallel especially and independence by fooling their doctors and nurses troubling given the legacy of feminist critiques of and by refusing to take medications they do not want or psychiatry. Caminero-Santangelo cites feminist believe they need. In my interpretation, the film – theorists who romanticise female ‘madness’ as based on the real Susanna’s memoir of her psychiatric potentially liberatory, and argues that these theorists institutionalisation during the 1960s (Kaysen, 1993) – thereby deny women’s legitimate pain and trauma, or offers this scene in such a way that the actors, playing relegate them to a nearly mythical status. For Caminero characters who are based on real individuals, can be read Santangelo, certain feminist portrayals of the as both antipsychiatric activists and as feminists. Later medicalisation and psychiatrisation of women suggest in the film, however, Susanna willingly takes that women have little or no agency. For example, if medication more than once, and in these scenes the women choose to take medication or ‘comply’ with suggestion is made to viewers that her choice was a other psychiatric interventions, some feminists may smart one to make if she wants to ‘recover’. label them as ‘sell outs’ who are willfully colluding with The contours of these complicated cinematic their own domination by pharmaceutical companies, representations of ‘non-compliance’ and ‘compliance’ western clinical biomedicine, and patriarchy writ large highlight why it is important that themes of (in short, women who make these choices may be seen victimisation, agency and choice are more robustly as ‘bad’ women and ‘bad’ feminists). theorised than they often have been by feminist There are strengths and weaknesses to all of these thinkers whose work addresses the terrain of women’s stances – protofeminist, feminist, antipsychiatric, or ‘mental illness’. While most members of the some combination of both. There are clearly multiple movement are against forced treatment, some of its and at times competing ideologies at work concerning members have publicly noted that to blame people for mental health treatment (including medication usage choosing to take medication or to seek and compliance), and conceptualisations of gender and psychotherapeutic services (including, in some cases, identity in relation to mental health issues. It is, I hospitalisation) is unhelpful and further stigmatises believe, important for those involved in mental health already stigmatised people, many of whom are women and public mental health to think critically about those (see Freedom Online www.mindfreedom.org, multiple ideologies. My own particular focus (see accessed 1 July 2005). Wiener, 2005a for a fuller account) has been on exploring how the discourses and debates surrounding The Loony-Bin Trip medication compliance are depicted in female Many memoirs written by feminist psychiatric survivors psychiatric survivors’ first person representations (on exist. Among the more recent is ’s The

journal of public mental health 44 vol 4 • issue 3 © Pavilion Publishing (Brighton) Ltd Antipsychiatry activism and feminism: the use of film and text to question biomedicine

Loony-Bin Trip (1990), an interesting entry point for For Caminero-Santangelo, Millett’s ‘The Loony-Bin considering the complex relationships between self- Trip… is perhaps the most remarkable literary testament representation, mental health care, antipsychiatric to the tension between experience and theory, between activism, and feminism. The Loony-Bin Trip is an the urge to bear witness and the temptation not to unapologetic narrative about institutionalisation, listen’. Caminero-Santangelo notes that Millett’s dual medicalisation, identity formation, and agency written role as ‘a recognized theorist of gender relations’ and as by a woman who is a renowned feminist activist, writer a ‘woman of the asylum’ are each brought ‘to bear on her (author, of course, of the groundbreaking Sexual Politics writing about her experience. They do not seem to (1970)), artist, art colony facilitator, teacher and coexist easily, and they provide striking gaps in the text’ mentor. Millett has also been a longstanding and (1998). Caminero-Santangelo overtly acknowledges outspoken participant in the US and international that Millett is an ‘antipsychiatric theoretician’ in her patients’ rights movements, and has openly identified as own right, but she, like Hubert, could say more about an ex-patient and psychiatric survivor in a variety of Millett’s leadership in the antipsychiatric activist world. public contexts. In recent years, Millett has been involved in the Mind Freedom and Mad Pride Dialogues with Madwomen movement, and has aligned herself others who criticise In addition to producing individualised stories in the mental health systems and psychiatric ‘care’ from a form of memoirs, feminist psychiatric survivors have also human rights perspective. One of Mind Freedom’s goals been telling their stories in collective texts – in books has been and continues to be to compel the American and online – and imaging their own lives via Psychiatric Association to provide ‘actual proof’ for the independent media projects. I would suggest that APA’s claim that ‘mental illnesses’ are biological (for independent cinematic, textual and online auto- more information about the Mind Freedom perspective, ethnographic representations reflect and shape models see http:www.mindfreedom.org). of psychological wellness and trauma in different ways I see Millett’s role as a psychiatric survivor from the way mainstream films and books reflect and spokesperson to be a central feature of her life as shape such models. They thereby have the potential to described in her memoir and within other arenas of her provide important and innovative understandings of the existence – arenas in which she does things besides diverse impacts of mental health practices in the present being a writer, such as talking one-to-one with other and past. activists, going to rallies, and doing public speaking. In In light of this, it is important to reflect upon the her analysis of The Loony-Bin Trip, Hubert does political implications of women – particularly female mention Millett’s involvement in ‘organizations psychiatric survivors and members of other historically opposed to forced hospitalization’ (2002) and discusses stigmatised groups – ‘taking back’ the camera and using her role as a psychiatric survivor activist. In my imaginatively other representational devices. While I estimation, however, Hubert’s invocations of Millett’s eschew an unrealistic obsession with seeking ‘truth’ or activist roles do not go far enough in describing these authenticity, and I believe that all representations and roles as Millett actually assumes them – quite enactments of identity formation are at least partially deliberately and consistently – both as a writer and discursively produced, I likewise believe that it is of ‘outside’ of, or in addition to, her life as a writer. In crucial importance that labeled-as-crazy women, in numerous respects, it seems to me that Millett is trying representing themselves, are indeed ‘talking back’ to substantially to intervene in how mental health issues mainstream society when they ‘take back’ the camera, are today rendered and interpreted in the public sphere. the pen and the keyboard. Therefore, in addition to the Hubert does provide an excellent discussion of vast array of historical and recent mainstream media Millett’s investment as a writer in arguing that representations and written first-person narrative psychiatric hospitalization is a form of ‘social control’. accounts that are currently available to a viewing and With regard to Millett’s memoir, Hubert notes that ‘[her] reading public, emergent forms of auto-ethnographic account of coercive treatment and forced hospitalization representation, including cinematic autobiography and offers a powerful critique of commitment procedures and family biography, internet self-representation and oral psychiatric practice’ and that ‘[b]y telling of her own history projects, present wonderful opportunities to experiences of “mental illness” and forced deepen clinical and activist work that is done ‘in the hospitalization, Millett advocates new ways of thinking field’ with psychiatric survivors. Further, these resources about the mind and its capacities’. Yet, Hubert’s can be used to expand curricula and to creatively train discussions of Millett’s relationship to antipsychiatric educators and mental health clinicians, thereby discourse make it seem that Millett has been powerfully expanding the boundaries of public mental health and ‘influenced’ by its proponents, and Hubert does not say mental health practice. enough about how Millett herself is among those A wonderful text for this type of public mental proponents as a leader and as a major force with whom health activist work is Allie Light’s award-winning to be reckoned. documentary Dialogues with Madwomen (1993).

journal of public mental health vol 4 • issue 3 45 © Pavilion Publishing (Brighton) Ltd Antipsychiatry activism and feminism: the use of film and text to question biomedicine

Dialogues presents the stories of seven female adopted as an identity that is strategically useful to those psychiatric survivors in San Francisco, including Light’s who choose it or otherwise accept it. There is a wide narrative of her own institutionalisation. A segment of range of perspectives on what it means to be ‘mentally Light’s own story is reprinted in Shannonhouse’s Out of ill’ or to be labeled as such, and the perspectives as they Her Mind (2000), and is entitled ‘Thorazine Shuffle’. are rendered by memoirs and other kinds of self- As some of its reviewers have noted, Dialogues breaks representational texts are clearly only one segment of a from conventional documentary formats and does not much larger range of perspectives. For some individuals rely even remotely on third person accounts. Like other who self-identify as ‘mentally ill’ and/or as c/s/x, creating ‘personal documentaries,’ Light’s work uses a and engaging identities that are nuanced and that combination of devices, including interview segments, possess agency may intersect with or come to represent illustrations, re-enactments, voiceover techniques and a stance often taken within disability studies. Beresford archival footage to draw in viewers. Light’s usage of re- (2000), an academic who writes ‘from the perspective of enactments is especially courageous, since the women a psychiatric system survivor’, has powerfully who narrate their lives in the film often perform the re- demonstrated the gains to be made from coalitions enactments of their own stories, rather than having between psychiatric survivors and individuals actors perform them. forwarding a disability studies agenda. As I remark in a Light presents a diverse set of perspectives on recent essay (Wiener, 2005b): ‘mental illness’ and does not seek to conflate her narrators’ experiences. The stories are presented in ‘Among our multiple projects and varied stances, segments, with the women ‘taking turns’ sharing their promoters of disability studies encourage individuals ideas and feelings, and the women’s explanations are and groups who self-identify as disabled to self- drawn together by Light into sequences that are cleverly empower. This is partly accomplished by de-linking edited. Some of the women subscribe to an emotional, cognitive, and corporeal identities of antipsychiatric stance (including, it seems, Light “difference” from explanatory models that herself), while others use and accept diagnostic individualize “illness” – and by moving away from categories and are grateful to take medications like the often disturbing advancements of Lithium. For example, one narrator talks insightfully and “patient” dependency models – about reading Quentin Bell’s biography of Virginia to critique and deconstruct power structures and Woolf and experiencing a profound identification with combat stigmatization.’ Woolf, as described by Bell. She realised at that moment that she ‘didn’t want to die’ as Woolf had, that Disability studies, like antipsychiatry, should of course her ‘ was not [her]’ but had ‘taken’ her over, not be presumed to be singular or monolithic. I would and she then decided to take Lithium – immediately – argue that disability studies practitioners and activists and has felt much better ever since. This narrator who are also c/s/x individuals have, therefore, the acknowledges that it was and is hard to give up what she potential to make profound and diverse contributions to refers to as her ‘imaginative aspects’ as she experienced our understanding of how biomedical models influence them when she was ‘manic’, and she cries as she public understandings of mental health and of disability describes wanting someone to love who understands her and, in addition, how we might intervene to produce and the ways she uniquely sees the world. alternative understandings. Many of the narrators in Dialogues describe Some c/s/x individuals, for example, may engage a horrendous and violent abuses that they sustained at the disability studies perspective to argue, in agreement with hands of family members and strangers, including sexual Millett, that psychiatry is a form of social control but assault and physical harm of various brutal kinds. that, in disagreement with Millett, being ‘mentally ill’ Graphic illustrations by children (as might be created can still be a productive identity formation. Others may during an art therapy session) and slow-motion black engage a disability studies perspective as a way of and white sequences are used to highlight the terror refusing to view mental illness as equivalent with these women endured. At the beginning of the film, ‘helplessness’ and ‘silencing’. The terms/concepts there is such a strong emphasis placed on these ‘helplessness’ and ‘silencing’ are not only problematic traumatic features of the women’s lives that viewers and frequently unhelpful to mental health users and might incorrectly but understandably assume that the consumers; they are so broad that they descriptively entire film will be about surviving trauma and enduring flatten the heterogeneity of human experience (see victimisation. By the end of the film viewers realise that Weiss, 2000). Individuals who choose to adopt a this is untrue. disability studies perspective might thereby inhabit a Being or being labeled ‘mentally ill’ can be difficult complicated life in which ‘mental illness’ is not in its embodiments, but as Girl, Interrupted, The romanticised but plays a fraught, crucial and meaningful Loony-Bin Trip and Dialogues with Madwomen each part (Wiener, 2005b). shows in a different way, ‘mentally ill’ can also be In conclusion, what is needed is a strategic response

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Hubert S (2002) Questions of power: the politics of women’s madness to psychiatry’s frequent preoccupation with compliance narratives. Newark, DE: University of Delaware Press/London: and ‘normality’ at the expense of other perspectives and Associated University Presses. ideas, and a continued challenge to the often Kaysen S (1993) Girl, interrupted. New York: Turtle Bay Books. individualising logic of the biomedical model. As noted Laing RD (1971) The divided self: an existential study in sanity and above, I believe that a continually rigorous and madness. New York: Penguin Books. interdisciplinary exploration of the complex and at Light A (2000) Thorazine shuffle. In: Shannonhouse R (ed) Out of times uneasy relationships between antipsychiatric her mind: women writing on madness. New York: The Modern Library. activism and feminism – especially in relation to the Millett K (1970) Sexual politics. Garden City, NY: Doubleday. activist work done by psychiatric survivors and disability Millett K (1990) The loony-bin trip. New York: Simon and Schuster. studies practitioners, and including the creative projects Showalter E (1987) The female malady: women, madness, and English culture, 1830-1980. New York: Viking. made available to us by c/s/x films and literary texts that Szasz T (1960) The myth of mental illness. American Psychologist 15 focus on the theme of civil liberty – is necessary and (February) 113-118. useful for pursuing social justice by working towards the Szasz, T (1973) The age of madness: the history of involuntary mental diminishment of mental health inequalities. b hospitalization presented in selected texts. Garden City, NY: Anchor/Doubleday. REFERENCES Szasz T (1994) Cruel : psychiatric control of society’s Beresford P (2000) What have madness and psychiatric system unwanted. New York: John Wiley & Sons. survivors got to do Szasz T (1984) The myth of mental illness: foundations of a theory of with disability and disability studies? Disability & Society 15 (1) 167- personal conduct. Revised edition. Los Angeles and New York: Quill. 172. Szasz T (2003) Pharmacracy: medicine and politics in America 2001. Breggin P (1992) Beyond conflict: from self-help and to Syracuse: Syracuse University Press. peacemaking. New York: St. Martin’s Press. Ussher J (1991) Women’s madness: misogyny or mental illness? New Breggin P (1995) Talking back to Prozac: what doctors aren’t telling you York/Hertfordshire: Harvester Wheatsheaf. about today’s most controversial drug. New York: St. Martin’s Press. Weiss A (2000) Autobiography of women’s madness: evidence of both Breggin P (1994) Toxic psychiatry: why therapy, , and love must agency and silence. MLS thesis. Eastern Michigan University. replace the drugs, electroshock, and biochemical theories of the ‘new Wiener D (2005a) Narrativity, emplotment, and voice in autobiographical psychiatry’. New York: St. Martin’s Press. and cinematic representations of ‘mentally ill’ women, 1942-2003. PhD Breggin P (1999) Your drug may be your problem: how and why to stop Dissertation. University of Arizona. taking psychiatric medications. Reading, MA: Perseus Books. Wiener D (2005b) ‘Normals, crazies, insiders, and outsiders’: the Caminero-Santangelo M (1998) The madwoman can’t speak: or why relevance of Sue Estroff’s medical anthropology to disability studies. insanity is not subversive. Ithaca/London: Cornell University Press. The Review of Disability Studies: an International Journal 1 (3) 76-82. Chesler P (1972) Women and madness. Garden City, NY: Doubleday. Cooper D (1970) The death of the family. New York: Vintage Books.

journal of public mental health vol 4 • issue 3 47 © Pavilion Publishing (Brighton) Ltd