This thesis has been submitted in fulfilment of the requirements for a postgraduate degree (e.g. PhD, MPhil, DClinPsychol) at the University of Edinburgh. Please note the following terms and conditions of use: This work is protected by copyright and other intellectual property rights, which are retained by the thesis author, unless otherwise stated. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given. Psychiatry Under Fire: Novelistic Challenges to Biomedical Psychiatry in American Fiction 1961-1964. Joanna Stevenson PhD English Literature The University of Edinburgh 2018 2 Declaration I declare that this thesis has been composed solely by myself and that it has not been submitted, in whole or in part, in any previous application for a degree. Except where stated otherwise by reference or acknowledgment, the work presented is entirely my own. Signed: Date: 3 4 Abstract American novels of the early 1960s posed a direct challenge to the legitimacy and apparent objectivity of biomedical psychiatry. Taken together, my selection of texts by Richard Yates, Ken Kesey, Sylvia Plath and Joanne Greenberg question the scientific validity of diagnoses of mental illness, as well as treatments such as involuntary hospitalisation, shock therapies, lobotomy, and the use of psychopharmaceuticals. These novels suggest that biomedical psychiatry functions as a form of social control by regulating and enforcing the categories of ‘madness’ and ‘sanity’ on the basis of compliance with social responsibility and expected behaviours. Accordingly, themes of autonomy and self-determination run throughout these texts as a traditional cornerstone of American culture to which the increasing omnipotence of psychiatric power is considered as a threat. In each chapter, I match a novel with a psychiatrist of the same or similar historical period, reading the fictional text through the framework of each psychiatrist’s position on their own discipline. I thereby demonstrate how these fictional texts either anticipated the work of the so-called anti-psychiatrists or appeared almost simultaneously. In Chapter One, I read Revolutionary Road alongside David Cooper’s Psychiatry and Anti-Psychiatry and argue that both texts depict the mad individual as immediately delegitimised as a socio-political agent through psychiatric diagnosis. I also argue that Yates uses the figure of the madman to demonstrate the absurdity of socially expected behaviours, thereby presenting the ‘mad’ paradoxically as truth-tellers who seek to reveal the illusory nature of American middle-class freedoms (particularly with regards to consumerism). In Chapter Two, I step inside the asylum by reading Ken Kesey’s One Flew Over the Cuckoo’s Nest alongside the works of Thomas Szasz. I argue that these texts staunchly position involuntary hospitalisation as both custodial and punitive, motivated by a desire to readjust the socially maladjusted for return to a rigidly controlled community. Both Szasz and Kesey reject the legitimacy of psychiatric diagnoses and understand the use of shock therapies and lobotomy to be acts of violence. Equally, Szasz and Kesey also prioritize individual self-determination over social cohesion, which again, like Yates’s Revolutionary Road, aligns psychiatric intervention with enforced conformity and the loss of civil liberties. In Chapter Three, I read Sylvia Plath’s The Bell Jar through the framework of R. D. Laing’s The Divided Self. I argue that Esther Greenwood’s psychotic illness manifests itself as a Laingian ontological insecurity, and that alter-egos like Elly Higginbottom function as part of a false-self system intended to preserve the outward appearance of normality. I also demonstrate how Esther experiences both self-alienation and psychiatric persecution as a direct result of her rejection of conservative gender roles and the social expectations therein. Finally, I reject Esther’s 5 ambiguous cure, positing instead that recovery is not possible within the society that caused Esther’s distress since socially expected gender roles are at the root of her trauma. Chapter Four occupies a unique position, offering a humane alternative to biomedical psychiatry. I argue that Joanne Greenberg’s I Never Promised You A Rose Garden, read in conjunction with works by Frieda Fromm-Reichmann, offers a vision of a different model of psychiatric engagement founded upon respect for patient autonomy and on self- realization rather than adjustment. In this text, Greenberg demonstrates the potential for asylums to be curative places of self-development, but only under very specific financial and ideological conditions. I suggest that, while Greenberg’s fictional version of the real Chestnut Lodge represents a highly elite and unorthodox facility, its approach towards patient care is a direct retort to the treatment of psychiatric patients portrayed in each of the other three texts. 6 Contents: Introduction 9 Chapter One 53 Revolutionary Road: Mental Illness and Socio-Political Control Chapter Two 111 One Flew Over the Cuckoo’s Nest: The Asylum and the Erosion of the Individual Chapter Three 187 The Bell Jar: Ontological Insecurity and the Curse of Womanhood Chapter Four 263 I Never Promised You A Rose Garden: The “thorn in psychiatry’s side” Conclusion 321 Works Cited 333 7 8 Psychiatry Under Fire: Novelistic Challenges to Biomedical Psychiatry in American Fiction 1961-1964. The 1960s were a period of great upheaval and change across the Western world. In the United States protests and anti-authoritarian movements developed around an increasingly broad range of issues, including the Vietnam war, the Civil Rights Movement, and the Women’s Movement, all of which sought to change or otherwise impact upon the socio-political landscape of the American nation. Psychiatry, this thesis argues, became another target of this anti-authoritarian bent in postwar America, since in the years immediately following the Second World War psychiatry had become an ever-visible and increasingly powerful presence in American communities. Psychiatric authority grew in the postwar years as veterans returned to America and quickly overwhelmed existing care facilities. The government, in response, offered generous levels of sponsorship for psychiatric training programs that sought to match and contain this increasing high demand. As Roy Menninger and John Nemiah have pointed out, “substantial federal support for psychiatric training” began after the Second World War, and this policy was so effective that the number of psychiatrists grew “from 4000 (in 1945) to more than 40,000” once the policy ended in the mid-1990s (74). Just as dramatically, Ellen Herman has pointed out that between 1940 and 1970 membership of the American Psychiatric Association rose “760 per cent from 2,423 to 18,407” (2-3). 9 While on the surface this enormous increase in psychiatric personnel might appear to be a progressive shift towards better care for those diagnosed as mentally ill, a counter-narrative arose that challenged the scientifically objective and morally neutral appearance of psychiatric medicine, both with regards to diagnosis and treatment. These individuals, who, however disparately, rejected psychiatry’s therapeutic function as well as its position as a medical science and suggested instead that psychiatric authority was primarily a tool for the quashing of troublemakers (political or otherwise) and the socially maladjusted. These criticisms rose to a crescendo during the 1960s and 1970s, and included the voices of psychiatrists, sociologists, anthropologists, and cultural figures including authors and filmmakers, amongst others. Personal autonomy versus social conformity was a fundamental issue to the majority of these psychiatric sceptics, many of whom were either psychiatrists themselves or had spent time either being treated or conducting research in psychiatric facilities. To some, including Beat writer Seymour Krim, the danger of psychiatric authority to individual freedom was so immediate that he considered it the duty of all independent thinker[s] and artist[s]….to be resolute towards a subtle, socially powerful god-father who often drips paternalism: namely, the newly-enthroned psychiatric minority that has elevated itself to a dangerous position of ‘authority’ in crucial issues of mind, personality and sanity (65). I argue that this call to action is reflected in both the non-fiction works and the novels to be discussed in this thesis. The issues of particular concern to these writers, including those to be discussed in this thesis, were largely 10 threefold. Of primary importance across the board, as mentioned, was the tension between individuality and forced conformity at the heart of psychiatric interventions. Relatedly, concerns were raised about the reduced potential for individual protest under a psychiatric system that, some have argued, delegitimizes the concerns of those who cause socio-political disharmony. Another major concern was the perceived brutality, and ineffectuality, of many biological treatments including shock therapies, lobotomy,