Speaking of peer respite (again), there are none in Minnesota, (despite them already existing in many Midwest states) meaning MN residents in crisis have no choice but to go to the psychiatric hospital, which is incredibly expensive and can be traumatizing and isolating.

(Peer respites are homelike, entirely voluntary environments for people in crisis, staffed by individuals with lived experience, and are usually free for their clients. You can come and go as you please, and are not isolated from the community like you are in psychiatric hospitals.)

HF2301 tried to ameliorate this problem by seeking funding for two peer respites, though it seems it was never picked up after 2019.

You can find the emails of the members of the Minnesota State Advisory Council of Mental Health here. I sent 'em an email already, as someone who is considering a move to MN who has multiple friends and loved ones in the state who could benefit from this service.

I think it's better if you write your own thing, but you want a template/example, here's basically what I said:

Hello, I am a(n) [MN resident/individual with loved ones in MN/concerned citizen/whatever you wanna put about yourself here]. As members of the State Advisory Council on Mental Health, I would love for you to revisit the idea of funding (a) peer-run respite house(s) in MN, as outlined in 2019's HF 2301. Peer-run respites are a homelike, cost-effective alternative to inpatient hospitalization for folks experiencing a behavioral health crisis, staffed by peers with lived experience. They are successfully run in at least 14 states and counting, and are a rising trend in the US. On average, they resulted in $2,138 lower Medicaid expenditures per month and 2.9 fewer hospitalizations for individual respite clients. (source) [feel free to put more data here if you know of any, there's a ton] There are currently zero peer-run respites in the state of Minnesota, despite the strong evidence base for peer support. I know many people who would benefit from such a service, especially individuals who do not qualify for inpatient hospitalization or would prefer a less clinical environment. [Thank you for considering/I hope you will consider this/etc] [Name]

Why do we continue to funnel money into psych hospitals when essentially every single suicidal person I've ever talked to has had an unhelpful or traumatic experience there, and the literature shows that people are more likely to attempt suicide AFTER leaving the psych ward, AND people hide their suicidality from loved ones and from providers - not just because of the stigma around suicide, but also because they're terrified of being involuntarily hospitalized and coming out with MORE trauma and crushing medical debt?

And NO, I'm not saying "defund mental healthcare", I'm saying we need to put funds TOWARDS other stuff that ACTUALLY prevents suicide - universal healthcare and housing, for one. Peer-run services that foster connection and community for folks - such peer respites, drop-in centers, support groups like Alt2Su, and warmlines, for another. And finally, actual quality therapy and psychiatry where people don't have to fear being coerced into a horrible situation if they're honest with their providers about what they're going through. Where there is a TRUE collaborative provider-patient relationship.

THAT is actual suicide prevention.

I am speaking as someone who has both been to and worked in psych hospitals. The patients are treated like shit. The staff are treated like shit. Most people don't "get better", they just learn how to lie their way out of there from other patients. I'm not saying they're NEVER helpful to anyone but holy fuck, we are doing people a disservice by acting like suicide prevention = more coercive psych wards with even more stringent "safety" rules that suck every bit of joy out of life for the patients (and many of the staff).

...Oh, and while we're at it, healthcare needs to be fucking free.

"The third, and equally critical component of the new penological disciplinary regime at Sing Sing was the development of techniques aimed at the discovery, classification, and eradication of sexual relations among prisoners. Sex had almost certainly been going on in prisons since the first prison was built. But the opportunity for sex had probably been much more restricted in the hard-labor prisons of the nineteenth century; and when hard industrial labor collapsed in many American prisons, as the contract system was dismantled, opportunities (and perhaps prisoners’ energy) for sex were greatly multiplied. Prison administrators of the early twentieth century appear to have known that prisoners were having sexual relations with one another. Nonetheless the subject was not openly discussed or theorized in any sustained manner.

This began to change in the 1910s. From the point of view of a penology committed to the socialization of prisoners as self-governing manly citizens, sexual relations between men posed a particularly urgent problem. Through the lens of the prevailing gender ideology of early twentieth century ... sex between men was intrinsically emasculating of at least one partner – the supposedly passive “receiver,” whether or not the sex was consensual. Such a feminized position, as it were, contradicted precisely the ideal of manly subjectivity that the new penologists sought to realize in prisoners. Added to this difficulty was the problem of “manly discipline”: The new penologists hued to an ascending, middle-class view that, rather than reflexively act on their sexual passions, men ought to channel or sublimate those passions into activities deemed socially or personally useful. On this view, then, the active or penetrative partner, although supposedly the masculine partner in the act, was failing to exercise manly self-discipline; he, too, presented a challenge to the manly ideal. In their Sing Sing laboratory, Osborne and his fellow penologists proceeded to drag prison sexuality into the light of day, examine it, and “cure” it.

Fragments of evidence from the New York prison records of the early 1910s suggest that sex among prisoners at Sing Sing and elsewhere had been happening for some years. In some instances, it involved physical coercion, but in many it did not. As James White’s report had suggested, sex was being traded for food or money as a matter of course. Various reports also suggested that, before Osborne arrived at Sing Sing, such relations mostly went unpunished, and that when a person was punished in connection with prison sex, it was usually in connection with a sexual attack. It was not the aggressor, however, who received the punishment: Any prisoner who complained to the warden that he had been coerced into sex, and any prisoner who sought protection from coerced sex, was likely to be severely disciplined, while the alleged attacker – or attackers – would probably not be disciplined at all. (One of Osborne’s predecessors at Sing Sing, Warden John Kennedy, had sometimes gone so far as to send the complainant, rather than the alleged attacker, to New York’s most feared prison – Clinton). Similarly, when Superintendent Riley heard of cases of sexual assault occurring during Osborne’s wardenship, he proceeded to order the transfer of the complainants to Clinton, which suggests that the punishment of the complainant was standard practice. Indeed, it is likely that the act of complaining, and not the act of sodomy per se, was cause for punishment in prisons of the 1900s and early 1910s.

Osborne and the new penologists broke with the usual approach to prison sex, and on a number of counts. First and most conspicuously, Osborne discoursed at some length – and in public – on what had thitherto been the taboo topic of sex in prison; in true progressive style, Osborne argued that in order to solve the problem, one had first to study and understand it. Describing sex between convicts as “vile” and as a “problem ... which should no longer be ignored,” Osborne made it clear that he considered sex between men to be one of the most serious and little-understood problems of the American prison. In his early speeches and writings on the topic, Osborne drew distinctions between different kinds of men who engaged in sex with other men. On the one hand, he explained to members of the National Committee on Prisons and Prison Labor (NCPPL), there was the man who “allows himself to be [sexually] used”; on the other, there was the man whose “passions are cut off from natural relief.” The latter, according to Osborne, was simply acting on an “ordinary” sexual impulse that, because of the deprived conditions of incarceration, had been directed toward a man, rather than a woman. As Osborne wrote in Prisons and Commonsense, “Here is a group of men – mostly young and by no means deficient in the natural passions of youth – but cut off from the natural means of satisfying them.” Osborne refined this rather crude typology a few years later, in a tripartite taxonomy recalling Sigmund Freud’s 1909 classification of inverts in Three Essays on the Theory of Sexuality: According to Osborne, in prisons one found the “degenerate,” whose “dual nature” made him the passive (and therefore feminine) partner of active, masculine men; the “wolves,” a popular term that Osborne appropriated to describe aggressive men who consistently preferred men to women; and the “ordinary men,” whose incarceration deprived them of their “natural” sex outlet – sex with women – and who consequently made use of other prisoners as “the only outlet” they could get.

Finding ways to channel the natural passions of “ordinary” men and youths turned out to be one of Osborne’s key projects at Sing Sing: Indeed it was a recurring theme of his wardenship. Osborne developed several tactics in his fight against the “vile” practice: He emptied the cellblock of the surplus of prisoners (whom he installed in a dormitory), so as to ensure that there was only one man per cell; he attempted to direct the natural passions of the supposedly ordinary men to nonsexual activities; he implored the Mutual Welfare League to police prisoners’ sexuality and to “condemn vice and encourage a manly mastery of the passions;” he set about identifying and isolating both the “degenerate” men who offered themselves as passive partners and the “wolves” who actively preferred other men; and he redoubled his efforts to smash the underground economy that James White had identified as a principal stimulant of prisoners’ sexual relations. (According to White, the systematic theft and underdelivery of prison provisions led to hunger among the prisoners, who then sold sexual favors for cash, and used the cash to buy the stolen food on the prison’s black market).

This latter tactic was especially crucial in Osborne’s strategy. As Osborne put it, every prison had “some degenerate creatures who are willing to sell themselves, any time, for a few groceries,” and the key to the prison sex problem in general was to ensure that prisoners were, on the one hand, well fed (and therefore not in need of procuring cash for extra food), and, on the other, afforded appropriate mental, physical, and spiritual outlets for their natural passions. In theory, the reconstitution of every prisoner as a waged consumer and producer in a simulated economy would ensure that the prisoner was no longer in a position of emasculating dependence. As long as convicts were eating well, engaging in a market economy that rewarded hard work and promoted financial responsibility, and sublimating their life force in educational and recreational activities, Osborne reasoned, the sex market in prisons would lose both its buyers and sellers.

Osborne’s conceptualization of the prison sex problem underscored the new penology’s central commitment to innovating various disciplinary activities that would absorb and direct prisoners’ energies in the face of limited industrial and other forms of labor. As the new penologists saw it, plays, motion pictures, lectures, musical events, and athletics not only addressed the problem of underemployment and initiated prisoners into the personality-building pasttimes of the ideal citizen, they sublimated the libidinal drive of the ordinary convict. Indeed, Osborne established a number of new activities at the prison in the name of vanquishing the “unnatural vice” that the prison investigators had documented in the early 1910s. Prisoners converted a basin in the Hudson River into a large swimming pool in 1915, because, as Osborne put it, swimming was a “practical method of reducing immorality” and an activity in which prisoners would “work off their superfluous energies. ... and head off unnatural vice.” (Four hundred prisoners per day were working off their “superfluous energies” in the pool by 1916). One of Osborne’s support committees, The New York State Prison Council, reiterated this point in defending the innovation of moving pictures, lectures, concerts, and other stimulating activities at Sing Sing. “These were established not as Amusements;” the Council explained somewhat defensively, “but as a definite means to an End” (caps in original): That end was “keeping the men out of vermin-ridden cells and of stimulating their minds – inured to the gray and sodden monotony of Prison walls.”

It was in no small part to combat prison sex that Osborne and the new penologists paved the way for the introduction of psychiatric and psychological testing to Sing Sing in 1916. Osborne and his supporters considered psychomedical study a crucial tool in their efforts to more accurately classify prisoners and to develop a specialized state prison system; to the classificatory system that administrators had established in the 1890s (and which classified and distributed convicts according to sex, age, sanity, physical fitness, and supposed capacity for reform), the new penologists added the distinctly psychological categories of sexuality and personality. In their view, sexual “degenerates” were a distinct category of prisoner and the prison system ought to identify and deal with them separately. Whereas the new recreational activities, better food, and prisoner self-policing were aimed at eradicating the sexual relations of the supposedly ordinary prisoner, the small army of doctors, psychiatrists, and psychologists who descended on Sing Sing in 1915 and 1916 were chiefly concerned with the group of prisoners Osborne had described as degenerate.

The new penologists’ effort to conscript psychiatry and psychology into prison reform was complemented by the reformers’ enhancement of general medical facilities at Sing Sing in 1915 and 1916. In February 1915, the New York State Department of Health inspected Sing Sing and recommended that a separate ward be set up for patients suffering from sexually transmitted disease (STD). This recommendation was seconded a few months later by two state investigators who suggested that Sing Sing open a new hospital in which “psychopaths,” STD patients, and convicts suffering from contagious diseases would be held separately from prisoners in the general wards. Those suffering from infectious diseases other than STDs would be labeled “normal,” while “psychopaths” and STD patients should be held in a ward for “special” cases. The investigators further recommended that a psychiatric study of prisoners be undertaken in which all new admissions to the prison would be thoroughly studied according to a case method, with special attention paid to those with mental and nervous disorders, “sexual perversions,” suicidal tendencies, and records of multiple convictions. The 1915 plans for a psychomedical facility at Sing Sing proposed a double innovation of the established prison system: The psychic lives of prisoners would be added to the fields of scrutiny, and the past and present sexual practices (and desires) of convicts would be read as signs of a peculiar psychic type (the psychopath), who, in turn, would be incarcerated in separate facilities.

The following year at Sing Sing, Dr. Thomas W. Salmon, of the National Committee for Mental Hygiene, and Dr. Bernard Glueck, a psychiatrist who had recently instituted nonverbal intelligence testing of immigrants at Ellis Island, set up the country’s first penal psychiatric clinic. Funded by a sizable grant from the Rockefeller Foundation, the clinic proceeded under Dr. Glueck’s directorship to examine virtually all of the 683 prisoners committed to Sing Sing between August 1916 and April 1917. Glueck’s dense, seventy-page report on his findings was published to much acclaim in 1917; it was the first comprehensive psychiatric case study of adult convicts in the United States. Like the Health Department investigators, Glueck conceived of his studies as just one element in the much larger effort to develop “rational administration” in imprisonment. He and his clinicians proceeded to interview every incoming convict about his family background, sexual practices, health, education, and employment history; they then conducted a series of psychological tests for “mental age” and dexterity, and administered psychiatric tests of the prisoner’s emotional state. On the basis of this information Glueck divided all the incoming prisoners into three groups: the intellectually defective (those with low “mental ages”); the mentally diseased (those who suffered from hallucinations and delusions); and the psychopathic, whom he described as the most difficult to define and the most baffling. He concluded that almost six out of every ten of the incoming convicts were either intellectually defective, mentally diseased, or psychopathic.

Glueck’s study of Sing Sing convicts was one of the first to theorize the existence of “psychopath criminals,” and his work became foundational both in studies of criminality and homosexuality. According to Glueck, approximately one in five of the incoming prisoners was a psychopath. It was to this category that those prisoners with a history of homosexual relations were most commonly consigned. As Glueck put it, the classification of psychopathic was a judgment of the prisoner’s entire way of life, not just the crime he had committed; sexual habits were one of four determining fields of enquiry (the others were the family’s medical history and the convict’s employment and education history). From the beginning, then, scrutiny of prisoners’ sexual relations – and homosexual relations in particular – was critical in the study of psychopathology among prisoners. He wrote that, “in contemplating the life histories of these (native-born psychopaths), one is struck very forcibly with the unusual lack of all conception of sex morality.” A wide range of sexual activities, and not simply sex between men, was read as psychopathological. He described one in three psychopathic prisoners to be “markedly promiscuous,” and nine percent as polymorphously perverse: He was perplexed to find that many individuals who had had “repeated” sexual relations with other men had been equally sexually active with women, and concluded simply that these convicts were not “biologically sexually inverted.” They were, however, as psychopathological as “biological inverts.”

....

As well as striving to discover, prevent, and punish sexual relations between convicts in the model progressive prison, the new penologists attempted to change relations between black prisoners and white prisoners. Unlike the matter of sex, neither the “race question” nor the prison’s small minority of black prisoners were objects of sustained discourse among Sing Sing’s reformers at this time. Nonetheless, race ideology deeply influenced and was, in turn, influenced by, the new penological program of reform. At Sing Sing (and at Auburn) the new penologists set about classifying and more formally segregating prisoners on the basis of the “one-drop” criterion of American race ideology. The new penologists conceived of their task primarily as one of assimilating prisoners born in Europe and native-born Americans classified as “white” to an ideal, manly citizenship. Programs that were designed to socialize prisoners as citizens were implicitly aimed at white native-born Americans and European immigrants; certainly, no resources were specifically earmarked for the education or postrelease employment of black prisoners. Many of the educational programs were specifically aimed at Italian, Polish, and German immigrants, with the objective of socializing them to be good Americans. Classes were started in English literacy and civics (the one at Auburn was known as the “Americanization” class) for white prisoners, and on at least one occasion, a large business enterprise sent an Italian-speaking agent to Sing Sing to train and recruit Italian convicts for postrelease employment. Besides crafting a prison program that took for granted that white convicts were the proper object of reform, the new penologists took steps to formalize and rigorously enforce the physical separation of white from black prisoners. Black prisoners were concentrated in the unskilled work companies, and white prisoners in the semi- and skilledlabor companies by day. By night, under Osborne’s direct orders, black convicts were segregated from white convicts. Early on in his wardenship, Osborne’s expressly prohibited white and black convicts to share cells with each other.

Black prisoners did not miss out entirely on the privileges and activities established under the new penologists. As a rule, privileges that were extended to white prisoners (such as membership in the leagues, participation in sports, etc.) were generally extended to black prisoners, too, suggesting that the new penologists considered black prisoners capable of participating in democracy and civil society. But, as had been the case at Auburn, these privileges were always extended in such a way that they would not undermine the segregation of white from black, nor, more critically, raise a black prisoner above a white prisoner. Indeed, new penological reform in general seems to have formalized race segregation and, not incidentally, widened racial inequality, at Sing Sing.

- Rebecca M. McLennan, The Crisis of Imprisonment: Protest, Politics, and the Making of the American Penal State, 1776-1941. Cambridge University Press, 2008. McCormick, p. 397-402, 404.

Image is Warden T. M. Osborne, Sing Sing, centre, surrounded by Sing Sing prisoners. c. 1915-1916. Bain News Service glass negative. Library of Congress. LC-B2- 3310-7.

AN OPEN LETTER to THE PRESIDENT & U.S. CONGRESS; STATE GOVERNORS & LEGISLATURES

Say NO to Loony-Bins: Immediate Action Required for Inpatient Psychiatric Care

2 so far! Help us get to 5 signers!

The current model of inpatient psychiatric care, which primarily focuses on safety and crisis stabilization, falls short in promoting sustained recovery. The prevalent emphasis on ultrashort lengths of stay often overlooks the need for comprehensive treatment plans.

A proposed model of care advocates for rapid diagnosis, goal-setting, and treatment modalities before initiating treatment, organized into three distinct phases: assessment, implementation, and resolution. This approach emphasizes individualized treatment and active patient involvement in treatment planning, addressing critical psychosocial aspects that are frequently neglected.

As we strive to reform the mental health care system, it's imperative to prioritize effective, recovery-oriented treatment strategies. This includes ensuring patient comfort and preferences are accommodated within reason. Considering patient preferences, like comfort items (such as safe stuffed animals; Share-Bears, if you will) and rescue medications (like melatonin,) is essential to upholding rigorous standards of care and safety.

Let's advocate for reforms that enhance patient-centered practices while adhering to established treatment guidelines and advancing recovery-oriented care.

Say no to “loony-bins;” those archaic relics that should be relegated to the distant past.

📱 Text SIGN PWORPV to 50409

🤯 Liked it? Text FOLLOW IVYPETITIONS to 50409

💘 Q'u lach' shughu deshni da. 🏹 "What I say is true" in Dena'ina Qenaga

World Mental Health Day 2023

Three posts in a week? Who am i!? I guess you could say I've been feeling inspired to write lately. I'm not complaining and I hope you aren't either!

Today, October tenth, is World Mental Health Day. While many areas of the world are becoming more open to talking about the impact of mental health, many people, countries, and faiths still don’t believe mental health is real or should be talked about.  I often say that I am so very grateful to have been born when I was and not mere decades before. I know that had I been born decades before and…

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By now, a majority of Autism researchers and clinicians are aware that the existing assessments for Autism are profoundly flawed. 

They know the standard evaluation of Autism is sexist, with assessors excluding women for reasons like wearing makeup, having a boyfriend, being superficially polite, or not being fixated on suitably ‘masculine’ topics like ancient Roman history or barometric pressure. 

They know Autism evaluations are racist, deeming Black Autistics “oppositionally defiant” or even “borderline” rather than acknowledging any social alienation or sensory pain they’re experiencing, and believing they must be overstating the difficulty they face in moving through the world.

And they certainly know that conventional Autism measures weren’t designed with adult Autistics in mind. Many of us are still asked to make up stories based on paintings of frogs in a toddler’s picture book, when we sit down for assessments at age 20, or 30, or 45 — because all the evaluation methods were written for young kids. 

The data has already proven the far-reaching consequences of using such shoddy measures of Autism. People of color, gender minorities, older adults, and women are diagnosed at later ages, and also go undiagnosed at massive rates. 

A growing population of scientists are admittedly interested in fostering a new literature of what they call “patient-driven” Autism research, but they never stop thinking of us as mere patients, the passive receivers of care rather than the leaders of communities and political movements who are the ought to be the primary authors of the studies about us, and the sole determinants of what our desired outcomes should be. Even when they observe that their work could benefit from a greater Autistic perspective, researchers do so from closed rooms, filled with other professionals who are largely not Autistic, wondering amongst themselves what it is that we want instead of learning to quiet their voices and follow our lead. 

Though many basically well-intentioned Autism researchers believe that Autism assessments need reform, what neurodiversity really needs is to abandon the diagnostic process altogether. If Autism is a benign, neutral, naturally occurring form of human difference that requires acceptance rather than a cure, then there’s no need to diagnose it as if it were a sickness. And if hundreds of thousands of Autistic women, people of color, queer people, and older people have been able to give a voice to ourselves and find one another without having ever been given a label by a professional, then improved professional labeling is not what we need. 

Autistic self-realization is the future of Autism assessment. We hold the collective wisdom, organizing ability, insight, and political power to define who we are. No authority figure should have to sign off on our identities. 

Because psychiatrists fail to diagnose such a large percentage of the Autistic population, many Autism researchers now accept self-identified Autistic adults within their subject pool. Within the peer-reviewed journal Autism in Adulthood, self-realized Autistics often make up the bulk of the participant sample, and they have repeatedly been found to be indistinguishable from their formally diagnosed peers. 

A growing body of research now also considers the presence of Autism-spectrum traits as qualifying for inclusion in many Autism studies. The data makes it quite obvious that Autistic people exist within all human groups, spread all throughout the world, and that a great many people have experiences in common with us who have not been formally diagnosed. This itself reveals that a formal diagnosis is hardly necessary, and that a psychiatric paradigm of accepting self-identification is inevitable. The researchers are increasingly already doing it.

You can read the full essay for free (or have it narrated to you!) at this link.

serious question but do you personally believe there is a way to approach psychiatry in a way that uplifts and upholds patient autonomy and wellness or is the entire trade essentially fucked haha. Btw this is an ask coming from a 3rd year med student—with a background of severe mental illness—who is considering a residency in psychiatry after receiving life-saving care in high school pertaining to said conditions. (I have peers who have been involuntarily hospitalized and treated horribly in psych wards, with approaches i patently disagree with, but was lucky not to experience. I don’t like modern american medicine’s approach to mental illness; “throw pills” at it to “make it go away” ie. a problem of overprescribing, inadequate and non-holistic approach to mental health, and i feel a lot of that can be attributed to the capitalistic framework. I also def agree with you that so much of what can be considered normal human responses to traumatic events/normal human suffering can be unnecessarily pathologized—a great example being the whole “chemical imbalances in the brain is the ONLY reason why im like this” argument that ive unfortunately fallen hard for when i was younger and am still currently dismantling within myself…and like dont even get me started on this field’s history of demonizing POC, women, LGBT, etc). Like i deeply love my psych rotations so far, and i utterly feel in my gut that this is the manner in which i would like to help people—a lot of whom are just like me—but im wondering if there is a way to reconcile these aspects in a way that one can feel morally okay participating within such an imperfect system, in ur opinion… ngghhhhhh i just want to be a good doctor to my patients…

(ps i love all ur writing and analysis on succession!! big fan mwah <333)

i don't mean to sound unduly pissy at you, specifically, but i do have to say: every single time i've talked about antipsych or broader criticism of medicine on this website, i immediately get a wave of responses like this, from doctors/nurses/psychs/students of the above, asking me to, like, reassure them that they're not doing something immoral or un-communist or whatever by having or pursuing these jobs. and it's honestly frustrating. why is it that these conversations get re-framed around this particular line of inquiry and medical ego-soothing? why is it that when i say "the medical encounter is not structured to protect patient autonomy or well-being," so many people hear something more along the lines of "doctors are mean and i wish they were nicer"? why is it that it's impossible to discuss the philosophical and structural violence of academic and clinical medicine without it becoming a referendum on the individual morality of doctors?

i'm choosing to read you in good faith because i think it's possible to re-re-frame this line of questioning to demonstrate to you the sorts of critiques and inquiries i find more interesting and more conducive to patient autonomy and liberation. so, let me pick apart a few lines of this ask.

"is the entire trade essentially fucked?"

if you're thinking of trying to 'reform' the project of medical psychology within existing infrastructures and institutions, then yeah, it's fucked. if you're still assuming that affective distress can only be 'treated' within this medical apparatus (despite, again, no psychiatric dx satisfying any pathologist's understanding of a 'disease' ie an aberration from 'normal' physiological functioning) then you're not challenging the things that actually make psychiatry violent. you're simply fantasising about making the violence nicer.

"I don’t like modern american medicine’s approach to mental illness; “throw pills” at it to “make it go away” ie. a problem of overprescribing, inadequate and non-holistic approach to mental health, and i feel a lot of that can be attributed to the capitalistic framework."

i hate when i talk about psychotropic drugs being marketed to patients using lies like the chemical imbalance myth, and then pushed on patients—including through outright force—by psychiatrists, and the discussion gets re-framed as one about 'overprescribing'. my problem is not with people taking drugs. i am, in fact, so pro-drugs that i think even the ones administered in a clinical setting sometimes have value. my issue is with, again, the provision of misleading or outright false information, the use of force and coercion to put patients on such drugs in order to force social conformity and employability, and the general model of medicine and medical psychology that assumes patients ought to be passive recipients of medical enlightenment rather than active participants in their own treatment who are given the agency to decide when and how to engage with any form of curative or meliorative intervention.

'holistic' medicine and psychiatry do not solve this problem! they are not a paradigm shift because they continue to locate expertise and epistemological authority with the credentialed physician, and to position patients as too sick, stupid, or helpless to do anything but receive and comply with the medical interventions. there are certainly psychotropic drugs that are demonstrably more harmful than others (antipsychotics, for example), and some that are demonstrably prescribed to patients who do not benefit from them and are even harmed by them. conversely, there are certainly forms of intervention besides pharmaceuticals that people may find helpful. but my general critique here is aimed less at haggling over specific methods of intervention, and more at the ideological and philosophical tenets of medicine that cause any interventions to be imposed by force or coercion on patients, then framed as being 'for their own good'. were suffering people given the information and autonomy to actually choose whether and how to engage in any kind of intervention, some might still choose drugs! my position here is not one of moralising drugs, but making the act of taking them one that is freely chosen and available as an option without relying on physician determination of a patient's interests over their own assessment of their needs and wants.

"so much of what can be considered normal human responses to traumatic events/normal human suffering can be unnecessarily pathologized"

true, but don't misunderstand me as saying that drugs or any other form of intervention should be forcibly withheld from those who do want them and are made fully aware of what risks and harms seeking them could entail. again, this would still be an authoritarian model; my critique is aimed at increasing patient autonomy, not at creating equally authoritarian and empowered doctors who just have slightly different treatment philosophies.

"dont even get me started on this field’s history of demonizing POC, women, LGBT, etc"

ok, framing this as "demonisation" tells me that you're not understanding that, again, this is a systemic and structural critique. it is certainly true that a great many doctors currently are, and have historically have been, outright racist, trans/misogynist, ableist, and so on. framing this as a problem of a well-intentioned discipline being corrupted by some assholes is getting it backwards. medicine attracts prejudiced people, not to mention strengthens and promotes these prejudices in its entire training and practice infrastructures, because of its underlying philosophical orientation toward enforcing 'normality' as defined by 18th-century statistics and 19th-century human sciences that explicitly place white, cis, able-bodied european men as the normal ideal that everyone else is inferior to or failing to live up to. doctors who really nicely tell you that you're too fat are still using bmi charts that come from the statistical anthropometry of adolphe quételet and the flawed actuarial calculations of metlife insurance. doctors who really nicely deny you access to transition surgery are still operating under a paradigm that gives the practitioner authority over expressions and embodiments of gender. the issue isn't 'demonisation', it's that medicine and psychiatry explicitly attempt to render judgments about who and what is 'normal' and therefore socially 'healthy', and enforce those standards on patients. this is not a promotion of patient well-being, but of social conformity.

"i deeply love my psych rotations so far, and i utterly feel in my gut that this is the manner in which i would like to help people"

let me ask you a few questions. you say that you like your psych rotations... but how do your patients feel about them? is their autonomy protected? are they in treatment by free choice, and free to leave any time they wish? are they treated as human beings with full self-determination? if you witnessed a situation in which a patient was coerced or forced into a certain treatment, or in which you were not sure whether they were consenting with full knowledge or freedom, would you feel empowered to intervene? or would doing so threaten your career by exposing you to anger and retaliation from your higher-ups? what higher-ups will you be exposed to as a resident, and then as a practicing physician? could you practice in a way that committed fully, 100%, to patient autonomy if you were working at someone else's practice, or in a hospital or clinic? could you, according to current medical guidelines, even if you had your own practice?

when you say "this is the manner in which i would like to help people", what do you mean by "this"? can you define your philosophy of treatment, and the relationship and power dynamic you want to have with any future patients? is it one in which you hold authority over them and see yourself as determining what's in their 'best interests', even over their own expressed wishes? have you connected with patient advocates, psych survivors (other than your friends), and radical psychiatrists and anti-psychiatrists who may espouse heterodox treatment philosophies that you could consider? do you think such philosophies are sufficient for protecting patient autonomy and well-being, or are they still models that position the physician's judgment and authority over that of the patient?

"im wondering if there is a way to reconcile these aspects in a way that one can feel morally okay participating within such an imperfect system"

and here is the crux of the problem with this entire ask. you are wondering how to sleep at night, if you are participating in a career you find morally distasteful. where, though, do your patients enter into that equation? do you worry about how they sleep at night, after having interacted with a system of social violence that may very well have traumatised them under the guise of providing help? why does your own guilty conscience worry you more than violations of your patients' bodies, minds, and basic self-determination?

i can't tell you whether your career path is morally acceptable to you. i don't think this type of guilt or self-flagellation is fruitful and i don't think it helps protect patients. i don't, frankly, have a handy roadmap sitting around for creating a new system of medicine and health care that rests on patient autonomy. affective distress is real, and is not something we should have to bear alone or with the risk of having violence inflicted upon us. what you need to ask yourself is: how does the medical model and establishment serve people experiencing such distress? how does it perpetuate violence against them? and how do you see yourself countering, or perpetuating, such violence as someone operating within this discipline? what would it mean to be a 'good' actor within a violent system, if you do indeed believe that such a thing is ontologically possible?

In neoliberal ideology, the self has replaced the group, the community, or wider society as the site for reform and change. This emphasis on the individual has seen the depoliticisation of social and economic inequalities to the point where, in the words of Ulrich Beck, they have been redefined "in terms of an individualization of social risks." Most pertinent to our understanding of the psy-professions in neoliberal society is that "social problems are increasingly perceived in terms of psychological dispositions: as personal inadequacies, guilt feelings, anxieties, conflicts, and neuroses". In this "risk society," "expert" groups such as psychiatrists and psychologists become increasingly important to capitalism in their attempts to scientifically speak to the "risky" behaviour of the individual. This rise of "expert knowledge and expert opinion" in neoliberal society, remarks Turner, means that such discourse is "highly politicized." Thus, as the social state has fallen away with the expansion of neoliberal ideology, the psy-disciplines have come to play a key role in promoting and perpetuating the focus on the risky subject, increasing their moral authority into new areas of jurisdiction, with every individual within a population redefined under a hegemonic psychiatric discourse as "in a permanent condition of vulnerability" to "mental illness."

Bruce M.Z. Cohen, Psychiatric Hegemony: A Marxist Theory of Mental Illness

and this is also why i think that any meaningful community building/advocacy/support around madness/neurodivergence/mental illness needs to be founded on principles of liberation and abolition, and that we need to be able to distinguish between people who are allies based on our shared values + goals, and between people who use some of the same language as us, but are fundamentally advocating for separate things.

One example I see a lot of is the idea of "lived experience" professionals, people who have a career in the mental health system and who also have some personal experience with mental illness. These professionals oftentimes will talk about their own negative experiences in the mental health system, and come into their careers with a genuine desire to improve the experience of patients. But their impact is incredibly limited by the system they have chosen to work in: the coercive elements of psychiatry incentivize professionals to buy into the existing power structures instead of disrupting them. And as a whole, many lived experience professionals end up getting exploited and tokenized by their employers and used as an attempt to make carceral psychiatry seem more palatable. Professionals in this dynamic are not working to effectively challenge the structural violence of their profession: they become complicit, even if they do also have good intentions and provide individual support.

(I do know some radical providers who have found innovative ways to fuck up the system and destabilize and shift power in their workplaces, but this is a very small number of providers and is not most of the lived experience providers I've talked with.)

Another example I see a lot in our spaces has to do with the evolution of the neurodiversity paradigm. I feel a very deep connection to the original conceptualization of neurodiversity and neurodivergent as coined by Kassiane Asasumasu, but in recent years I've seen a lot of people using neurodivergent language in a way that feels pretty dramatically different than the foundational principles. This isn't saying that people should stop using ND terminology or that all neurodivergent spaces are like this--rather, I just want to point out some trends I see in certain communities, both online and in my in personal life. Although people will often use neurodivergent language and on the surface, seem allied with concepts of deinstitutionalization, acceptance, etc, the values and structure in these community spaces often rely heavily on ideas of classification based in DSM, and build very prescriptive and rigid models for categorizing different types of neurodivergence in a way that ends up excluding some M/MI/ND people. Certain types of knowledge are valued over other types of knowledge, and certain diagnoses are prioritized as worthy of support over others. There's a lot of value placed on identifying and classifying many types of behaviors, beliefs, thoughts, actions, into specific categories, and a lack of solidarity between different diagnoses or the wider disability community.

Again, this isn't to say that ND terminology is bad or useless--I think it is an incredibly helpful explanatory model/shorthand for finding community and will call myself neurodivergent, and find a lot of value in community identification and sharing of wisdom. I just feel like it's important to realize that not every ND person, organization, or initiative, is actually invested in the project of fighting for our liberation.

when thinking about our activism, as abolitionists, it's important to be very specific about what our goals, values, and tactics are. For example, understanding the concept of non-reformist reforms helps us distinguish what immediate goals are useful, versus what reforms work to increase the carceral power of the psychiatric system. And when building our own value systems and trying to build alternative ways of caring for ourselves and our communities, we need to be able to evaluate what brings us closer to autonomy, freedom, and interdependence. I need people to understand that just because someone is also against psych hospitalization does not mean that they are also allies in the project of letting mad people live free, authentic, meaningful, and supported lives, and that oftentimes people's allyship is conditional on our willingness to conform to their ideas of a "good" mentally ill person.

Experts and lawyers involved in sexual offence cases in Britain have warned that suspected rapists are evading justice by claiming to have a rare sleepwalking disorder that causes them to engage in sexual activity while asleep.

They said there had “definitely” been cases where guilty people had been found not guilty, and warned of the potential for further miscarriages of justice – and harm to the public – without more robust challenges to “sexsomnia” claims put forward by defendants.

The warnings come after an investigation by the Observer uncovered a rise in the use of “sexsomnia” as part of defence cases in criminal trials. It found 80 cases over the past 30 years where defendants accused of rape, sexual assault or child sexual abuse claimed to have been sleepwalking or suffering from sexsomnia at the time.

But while there were only occasional cases in the 1990s and early 2000s, the analysis reveals at least 51 in the past decade and eight in the past year alone. The figures are likely to represent only part of the true total, with many not publicly reported. In about 60% of cases where sexsomnia was part of the defence, a not-guilty verdict was returned, the Observer’s analysis suggests. Overall, the average jury conviction rate for rape was 58% in England and Wales.

Charges against suspects have also been dropped by the Crown Prosecution Service before they even reached court after defence lawyers raised sexsomnia behind the scenes. One law firm advertised how it “kept pressure” on the CPS after it decided to continue with the prosecution of a wealthy client charged with sexual assault. The charges were dropped before the case went to trial.

Dr Neil Stanley, an independent sleep expert who has provided expert evidence in trials where sexsomnia was raised as an issue, said that while some claims of the condition were undoubtedly genuine, others were not.

“It is being used cynically,” he said. “There are cases that are in the public domain where it is clear that they’re just chancing their arm. Because, of course, if it is sexsomnia, you’re found not guilty. Judges haven’t a clue. Juries haven’t a clue. So it’s worth a try.”

Stanley said attempted use of sexsomnia by defendants had “massively skyrocketed” in recent years and that such claims were very difficult to definitively disprove – meaning often “just saying, ‘I don’t remember. It could be sexsomnia,’ is enough”.

He said the current system was failing victims – and true sufferers of the condition – and called for reforms including more robust challenging of sexsomnia claims and a less adversarial approach to questioning expert witnesses, so they could provide more nuanced responses in the courtroom.

“The law seems not willing to admit that there’s a strong likelihood of miscarriages of justice. And given the severity of the offence, we should be very certain of having checks and balances in place so we take as many precautions as possible to stop miscarriages of justice,” he said. “In terms of sexsomnia, that is not happening.”

He added: “I know in my heart of hearts that there are cases where guilty men have got away with it. And that cannot be a legitimate consequence of the system. The system has to change.”

Sexsomnia is recognised in the DSM-5 diagnostic manual of psychiatric conditions and is a type of para­somnia, a disorder involving abnormal sleep behaviour. Sufferers engage in sex acts while in non-REM sleep. They might have their eyes open but will have no awareness or memory of their behaviour.

If a jury decides that an accused person was in such a state – known as “automatism” – when they committed an alleged offence, they will be found not guilty. But while lab tests and partner histories can be used to try to establish whether a sexsomnia claim is genuine, sleep experts and lawyers say the system is open to abuse because uncertainty in the science means it is impossible to say for sure whether someone was or was not suffering from sexsomnia.

Many of those successfully pleading sexsomnia in court had no known history of sleepwalking and no formal diagnosis. Other cases involved defendants performing a complicated series of actions in unfamiliar settings, which experts said were less typical of genuine sexsomnia.

In about a third of the cases, the defendant was under the influence of alcohol or drugs, and some were very intoxicated, but sexsomnia was cited as the primary factor behind their behaviour.

Sometimes, just a mention of the condition in court appears to sow a seed of doubt that can contribute to a not-guilty verdict. In one rape case, two expert witnesses said evidence for the defendant having sexsomnia was “weak” but that they could not categorically rule it out. The jury subsequently acquitted the man.

In at least one case, a man who avoided a rape prosecution after claiming to have sexsomnia went on to attack again. Joseph Short evaded charges in 2011 after saying he had no memory of an alleged rape. He was later jailed for 15 years for another violent attack. And a man convicted of strangling and beating his partner was acquitted of raping her and another woman after claiming to have been suffering from the condition.

Allison Summers KC, a barrister and head of Drystone Chambers, who has represented three clients who used sexsomnia as a defence, all of whom were acquitted, said the increase in defences using the condition could be in part because it had historically been “underdiagnosed generally” and that there were some “very genuine” cases.

But she said the presence of alcohol complicated things – “are they using the sleep defence to cover up what has happened?” – and that there was an issue of defendants “trying it on”.

“I think there are probably [defence lawyers] running these cases on fairly spurious evidence,” she added. “Juries are strange creatures and I suspect sometimes they give the benefit of the doubt when they shouldn’t.”

Summers said it was for defence counsels to investigate such claims and for prosecutors to robustly challenge them, but that this did not always happen: barristers instructed “rubbish” experts or failed to get relevant histories, or prosecutors did not properly interrogate claims in court. “It comes back to laziness and a lack of understanding,” she said.

Sexsomnia has also been used by defence teams in an attempt to discredit victims. Jade McCrossen-Nethercott, 31, from Croydon, is taking legal action against the CPS after it dropped her rape case days before it was due to go to trial after expert witnesses said she had sexsomnia.

McCrossen-Nethercott said the conclusion was made by an expert instructed by the defence who had never met her, and was based on her answers to a 15-question survey. “It was plucked out of thin air,” she said.

The CPS has since “apologised unreservedly” for its decision to drop the case and said “the expert evidence and defendant’s account should have been challenged and put before a jury to decide”.

McCrossen-Nethercott is now calling for “robust, rigorous and consistent” assessment of sexsomnia claims “across the board”, including a “thorough assessment, bed partner histories, extensive polysomnographies”.

“It has to be taken seriously to protect victims from being told they have it without significant evidence; to prevent perpetrators claiming they do when they don’t, but also for genuine sufferers, to prevent them being wrongly convicted,” she said.

Dame Vera Baird KC, the former victims’ commissioner for England and Wales, called for safeguards to be put in place to protect victims and the public. She said sexsomnia was being seen as an “escape route” by some defendants and that in cases where it arose, prosecutors needed to be consistent in applying for sexual risk orders, which can be made regardless of whether someone is convicted if they are deemed to pose a danger.

Such an order could require a person to warn future partners, or others sleeping under the same roof, about their condition, or face prison.

Baird, a barrister who was previously solicitor general and a Labour MP, said increasing the use of such orders might also deter people from using sexsomnia as a “get-out-of-jail card”. “A person who says, ‘Oh dear, I raped somebody without knowing it,’ is a danger to the public and cannot be left simply acquitted,” she said.

A CPS spokesperson said prosecutors always “robustly challenge legal defences when contrasting evidence is available” and that sexsomnia was no exception. It said any decision to drop a case in response to a claim of sexsomnia “must now be approved at the most senior level” and that victims always had the right to seek a review. However, it said it did not record data on how many cases had been dropped due to sexsomnia claims by the defendant.

The Ministry of Justice said the government had taken “decisive action” to ensure rape victims got justice and that “the validity and credibility of a defence” was for the courts to decide.

Claire (not her real name), a complainant in a recent case where the defendant was acquitted on multiple counts of sexual assault after claiming to have sexsomnia, said the verdict had a “devastating” effect. She said the man did not deny the acts took place but said he must have done them while asleep, and that he had never sleepwalked before, had no formal diagnosis, and had had “no tests done”.

The woman, a mother from Lancashire, said the process had left her “baffled”: “It’s like they’ve said, ‘Well yeah, he might’ve sexually abused you numerous times but he did it in his sleep, so it’s OK. So you’re just going to have to get on with your life and deal with it and he’s got away with it.’ It’s like they just took his word for it. There is nothing to stop him from doing it again and just saying, ‘I was asleep’.”

What were Victorian mental asylums like?

Since we're getting to know Jack Seward, I though it would be useful to find out a bit more about Victorian mental asylums of the kind that he owns.

I'm putting this under a cut for discussion of psychiatric abuse, involuntary hospitalisation, and ableist language in historical documents.

The pre-Victorian context

Pre-Victorian asylums were horrific for the poor. Wealthy patients were accommodated in private asylums that were much like private homes, where patients could bring in their own cooks and go out hunting, but poor patients were treated like animals, sharing beds in outbuildings, and often kept chained up or in straitjackets. Part of the problem was that there was simply a shortage of asylums for the poor, leading to overcrowding. (Source)

But by the early 19th century, reformers like Harriet Martineau and Samuel Tuke argued for better treatment, and especially opposed the use of restraints. Asylums gradually moved from treating patients like prisoners to treating them as people in need of care. In 1829, William Scrivinger, a patient at Lincoln Asylum, died after being left in a straitjacket overnight without supervision, which also acted as a spur to that asylum and others to move away from restraining patients. (Source)

Entry to an asylum

The process of reform continued with the 1853 Lunatic Asylums Act. This laid down the process of admission to asylums.

For private asylums (like Seward's), for someone to be admitted they had to have a medical certificate signed by two medical professionals. In theory, that safeguarded against abuse (i.e. people being sent to asylums for spurious reasons) though in practice, if you were willing to pay for a private asylum for a relative, it was relatively easy to persuade two medical professionals to sign off on admission. Women were sent to asylums more often than men, including for "immoral behaviour" such as having an illegitimate child. (Source)

Ticehurst House, a private asylum for the wealthy

Asylums for the poor required a certificate from a single medical professional as well as an order from "a Justice, a Clergyman, an Overseer, or the Relieving Officer (under the Poor Law)". The law straddled the line between the previous carceral approach (requiring any "Lunatic" "wandering at large" to be apprehended, examined and brought to an asylum if necessary) and a protective approach, with legal requirements to look after anyone who "is cruelly treated or neglected by any Relative or other Person having the Care of Charge of him".

What the law didn't provide was any way for the person being taken to an asylum to overrule the decision. They couldn't appeal for their own release, but could be released if a relative or friend were available to take care of them and prevent them from harming themselves or others. (Source)

Life in an asylum

The ward for female patients in Prestwich Asylum, near Manchester

Patients were kept strictly segregated by sex. It was typical to have 10 patients to every member of staff. During the day, patients were often encouraged to work, the men in farms on the grounds (which also helped asylums save money as they could grow their own food) and the women in laundry, cooking or sewing. In the evenings there would be plays, concerts and parties. (Source 1, Source 2)

This was grounded in the principles of "moral therapy", which aimed to teach patients how to fit in and be productive members of society. That sounds a bit grim, but its aim was to be gentle and humane with patients, and to help them live well outside of the asylum. (Source)

When Seward says:

I seemed to wish to keep him to the point of his madness—a thing which I avoid with the patients as I would the mouth of hell.

... this is probably a reference to the principles of moral therapy. Seward's role is to guide patients away from unwanted behaviour, which is why pushing Renfield to "the point of his madness" would normally be antithetical to Seward's treatment approach.

Other treatment varied. Some treatment was ineffective but harmless (e.g. warm baths for patients with depression), but other treatment was more extensive and actively unpleasant or even dangerous (e.g. "cold water therapy": pouring cold water over agitated patients until they calmed down).

[EDIT: I realise from some of the tags that I've given the wrong impression about this. It could be like being given a short cold shower... or it could be people having water poured over them for hours, or being ducked in a pond until they nearly passed out.]

There were very few drug treatments except sedatives, and some of the worst historical psychiatric treatments, like electroconvulsive therapy and lobotomies, weren't introduced until the 20th century. (Source)

By the end of the century, though, the improvements made by early reformers were going into reverse. Restraints and padded cells made a return, especially for poorer patients, and government-funded asylums faced overcrowding and could no longer provide careful, personalised care. (Source)

Modern-day equivalents

Holme Wood, a former asylum that's now an old people's home

I might be off base on this, but reading about Victorian asylums reminded me of nothing so much as modern-day old people's homes, at least in the UK.

They're intended for the care of a group of people who are often marginalised.

They're often in grand old buildings - in some cases, the same grand old buildings, like the one above.

If you're wealthy, they offer a high standard of care that's similar to your life not in the asylum/home.

Poorer people end up in state-funded care that most people agree fall short of the ideal.

Being able to leave the institution can be tricky, and often depends on having supportive friends or family members.

There are regular scandals in which patients are treated appallingly.

But the provision of care for the elderly/mentally ill is known to be a large, intractable problem; pretty much everyone in our society thinks we should do better but figuring out how to achieve that isn't easy.

I don't know how useful a perspective this is? But it feels illuminating to me, particularly in terms of how the care of people in asylums might have been perceived in wider society. If I were producing a modern-day Dracula AU, I think putting Jack in charge of a care home could give the same impression to a modern audience as an asylum would to a Victorian one.

my possibly unpopular opinions on therapy/psychiatry

- Just like suffering is not inherent to womanhood, suffering is not inherent to humans. Just like it is not okay to just expect that women will be subjected to suffering, it is not okay to expect that it will happen to anyone and it's just the way things are.

- Therapy is not inherently wrong for trying to alleviate the suffering, but I fail to see the doctors acknowledging the fact that the suffering is a collectively shared experience, and suffering is caused by someone. Moreover it is the whole point of therapy to focus on just yourself, "take responsibility"(for the harm that was done to you?) and seeing what you can make do. Basically because again, doctors cant really tell their patients to go overthrow the gvt or divorce their shitty husbands. Thus endless copium instead of, yknow... something actually meaningful.

- Antidepressants arent inherently bad but they cant cure you. They are just psychoactive drugs. Caffeine, tobacco, cocaine, they all are psychoactive in one way or another, and your brain doesnt really care if the substance is legal, illegal or prescribed. It modifies the symptoms but it cannot actually cure you. Or something. If you struggle with depression/anxiety related issues, I would highly recommend that you try to look for a way to alleviate them that is not just you popping pills for 10 years in a row.

- Our society is purposefully built to fuck us up. Just like "dyslexia" is not a thing in societies that dont have a writing system, "ADHD" or "depression" or "anxiety" are non-syndromes, they show only in very specific circumstances. It is possible to reform the world so that it doesnt force suffering and disabilities onto people.

- Psychoactive drugs that actively alter people's neurochemistry and may lead to both psychological and physical dependency are catastrophically overprescribed and one day the big pharma will be held accountable for their crimes lol

- I repeat that I do not oppose psychiatric medicines as a concept. Psychiatric disorders fuck people up, I know it personally. BUT. Sorry but there is a difference between a socially-induced disorder like anxiety, and a disorder of a purely biological genesis like bipolar mania or schizophrenia. I dont think depression or anxiety are easy. But consider what, someone suffering from delusions in mania cannot CBT their delusions away, they basically have to be on meds. MAYBE think really hard of the pros and cons here. You are lucky to have a relatively healthy brain, dont wash it down the drain.

- Medicalization and profiting off of any suffering is highly concerning. The transgender pharma will also pay for their crime of persuading (otherwise healthy) people that they cannot exist and will literally kill themselves without unnecessary medications and surgeries.

- If you have agreed on me on the previous points but my opinion on transness triggered you, consider unbrainwashing yourself? Idk? Can't you put 2 and 2 together? These are literally the same kind of phenomena.

- I say it all as someone who has been on antidepressants for a long time, and also who knows many people who were on antidepressants for a long time. I've seen both huge benefits and huge debilitating side effects.

As a matter of fact I am also completely normal and can be trusted w

Sometimes, when talking about the current psychiatric system, we get lost in anger and don’t look towards alternatives and what a better tomorrow might look like. Here’s some cool mental health/psychiatry reform things that I think are neat (Somewhat US centric bc that’s where I live). Lots of them focus on psychosis, because I think psychosis is a sorely ignored subject in mental health activism.

US Peer Respite Directory - A list of voluntary, community-based, non-clinical crisis support group-home like environments that are staffed by people with lived experience of mental illness and/or lived experiences in the psychiatric system.

Students With Psychosis - A nonprofit that empowers students with psychosis through virtual programming, support groups, etc. They’re run by the amazing Cecilia McGough, an advocate with schizophrenia.

Hearing Voices Network - A network of support groups for people who hear voices, see visions, and have other extreme experiences. Focused on supporting individuals without judgement and giving them a place to explore their experiences and grow from them.

Open Dialogue - An psychosocial approach to psychiatric services that focuses on treating clients with respect, shared decision-making, dialogue between client, providers, and family (if the client wants family involved), and more minimal use of medication.

CommonGround software - A software developed by Dr. Pat Deegan that allows clients to communicate their needs to their providers more efficiently to support shared-decision making. Dr. Deegan has a lived experience of being diagnosed with schizophrenia and believes in personal medicine and med empowerment.

Project LETS - A radical approach to peer support and healing that has a disability justice centered approach, giving people with lived experience a voice and focusing on mutual aid. They provide peer mental health advocates, self-harm prevention, and more.

Integrative Psychiatry - A holistic form of psychiatry that focuses on nutrition, exercise, therapy, and psychosocial factors, where medication is just an aspect of treatment. US database of integrative psychiatrists here.

Soteria Houses - Community homes with peer support that provide residents with personal power, responsibilities, and “being with” residents, that focus on a humane and person-centered approach.

Relating to Voices Using Compassion Focused Therapy - A self-help book by Drs. Eleanor Longden and Charlie Heriot Maitland about managing distressing voices and building a respectful, cooperative relationship with them. Views voices as potential allies in emotional problem-solving rather than enemies.

Clubhouse International - A non-profit organization that gives people with mental illness opportunities for friendship, employment, housing, educational, and medical services all in one place. It was founded by a group of friends who survived a psychiatric hospital together.

Psychosis Research Unit - A group of psychology researchers who are doing research on and developing psychotherapeutic techniques for coping with and managing psychosis, such as CBT for psychosis and Talking with Voices therapy.

"It was at Sing Sing that the instrumentalization of new penological reform found its fullest expression. More than any other prison warden, Sing Sing’s Lewis E. Lawes insisted that the best prison was one in which the prisoners were well-fed, well-exercised, and frequently entertained. Lawes had risen through the ranks of prison administration from the position of prison guard at Clinton, in 1905, to that of Superintendent of the New York Reformatory for Boys, in 1916, and, finally, in 1920, to the wardenship of Sing Sing. He brought with him an unusually acute understanding of the peculiar problems that beset prison administrators in the years after the abolition of prison labor contracting. A first-hand witness to the great disciplinary and political crises that beset New York’s penal system in the early Progressive Era, he also had an intuitive grasp of the “unwritten law” of the prison that the convicts would forcefully defend what they took to be their fundamental rights. Between 1920 and 1943, Warden Lawes carefully and skillfully constructed a prison order based on the principle of the square deal and the morale-building techniques that Moyer had begun to refine at Sing Sing. Grasping that the stability of the prison also depended upon outside forces, he also worked tirelessly to legitimize his administration in a slew of books, articles, radio shows, and Hollywood films.

When Lawes arrived at Sing Sing in 1920 to take up his wardenship, he gave all the prisoners a clean disciplinary slate and placed them in “A” grade. As “A graders,” they were entitled to all entertainment and recreational privileges. Lawes explained that if they broke a rule, they would be demoted to “B” grade, with limited privileges. A further offense would land them in “C” grade, with no privileges. Good behavior would result in promotion to a more privileged grade. As part of this overhaul of the disciplinary system, Lawes reorganized the sale of tobacco and other comforts at the prison, linking the purchase of those “pleasures” to the disciplinary system: He merged the two commissaries to create a single grocery store, and authorized prisoners to purchase a set amount of goods each week, to be determined by the grade they were in. Lawes then set about extending sporting activities at Sing Sing and made the mass media of radio, film, and newspapers part of the fabric of everyday life. He installed a master radio receiving station in the east wing of the prison and appointed a civilian censor, who then relayed selected radio programs to loud speakers and headphone sets around the prison and cellhouse. He also expanded the prisoner baseball program, established a football team, laid down playing fields and handball courts, and gave the prisoners three hours of outdoor exercise time every afternoon in the summer months. Like Moyers and Osborne before him, Lawes continued the practice of having outside teams come to play the prisoners; in 1925, he also organized a memorable ballgame on the prison diamond, between the New York Giants and the New York Yankees (Babe Ruth was reported to have hit the ball over the field wall for a home run; unfortunately, the outcome of the game appears not to have been recorded). Although Lawes understood prisoners’ conception of their elemental rights, he recognized few of these rights as having any basis in positive law (the two he did explicitly acknowledge as properly legal were the right to attend a religious congregation of the prisoner’s choosing and the right to a minimum food allowance.) Nonetheless, Lawes’s actual management of the prisoner indicates that he understood the force of custom in the prisons and that he was very attentive to convicts’ sense of fairness in all his dealings with them.

As at other New York prisons, the new warden retained the Mutual Welfare League (MWL), chiefly as an organizing staff by which to provide entertainments, education, and recreation, and as a disciplinary agency, by which convicts who transgressed minor rules would be policed and punished. Lawes also moved to consolidate his administrative powers viz. the MWL (which, just like outside reformers and embattled politicians, was a potentially disruptive force from the administrators’ point of view). In particular, he took steps to mute the league’s voice beyond the prison walls and to curtail the scope of its activities within the prison walls. The administration clamped down on prisoners’ correspondence with the outside world, and warden Lawes established a censorship office where all prisoners’ outgoing correspondence (whether letters to loved ones or short stories for publication) and incoming mail were scrutinized for subversive content. Lawes also restructured the league’s election process and prohibited the prisoner “political parties” that had emerged in the late 1910s, on the grounds that prison-yard electioneering was overly exciting and emotional for the prisoners, and hence damaging to prison morale. From 1920 onwards, the league’s primary obligation was to regulate the leisure hours of prisoners, Lawes directed; its other obligations were to maintain discipline at these events and to represent prisoners’ grievances and requests to the warden: “The League was to be a Moral force,” insisted Lawes; “If it could not sustain itself in that capacity it was futile and should be eliminated.”

Lawes also maintained the automobile, barber, cart, and tailoring classes and made reading and writing courses compulsory for all illiterate convicts. By 1934, all convicts were routinely administered educational tests. Those achieving lower than the level of the sixth grade were then enrolled in classes taught by a civilian head teacher, two civilian assistant teachers, and twenty grade school convict teachers. Ten prisoners taught more advanced courses, and several convicts were enrolled in correspondence college courses run by the Massachusetts Department of Education. It was under Lawes that psychomedical therapies became a critical component of the disciplinary regime, not merely as a means of classifying prisoners (as the new penologists had initially envisioned them), but as a means of managing convicts’ daily frustrations, depression, and desire to rebel. Like the educational, recreational, and athletic programs, the psychomedical sciences were given over to the therapeutic pacification of convicts. Glueck’s psychiatric Classification Clinic was reorganized and funded by the state in 1926 and proceeded to surveil the entire prison population; clinicians also began attending the warden’s court to give advice on disciplining rule-breakers. Convicts were encouraged to seek psychological and psychiatric advice from Dr. Amos T. Baker and his staff of psychologists and psychiatrists. Throughout his career, Lawes repeatedly made it clear in press releases, radio interviews, and a series of books and articles that high prisoner morale was the immediate objective of his penology, and the peace and security of the prison were his foremost concerns. As he put it in an interview in 1924, under his system:

The men are no longer bottled up, constrained to silence, tyrannized and brutalized by unworthy keepers, or exploited and spied upon. They are permitted some chance of self-expression, some freedom for their personalities. They are shown humane and constructive precepts and they are not repressed, screwed down and baffled. The result is that we have almost done away with those emotional explosions so common in the older kinds of prisons. All acts of violence and attempts at escape are the result of these emotional disturbances.

Lawes conceptualized the various reforms initiated by the new penologists as means to the end of higher morale. On the question of education, for example, Lawes justified the expense of running classes for prisoners: “To me, as a warden, prison schools more than justify their continuance and expansion if for no other reason than to foster and maintain the morale of those prisoners who take advantage of the facilities offered them to study and to learn.” In a similar vein, Lawes argued for the benefits of commercial radio at Sing Sing: “I am happy to report,” he wrote in Radio Guide in 1934, “that since this system has been in vogue, the morale and behavior of the prisoners [have] rocketed sky-ward.” As Lawes conceptualized it, the proper objective of prison management was to facilitate “decent, normal and satisfying expression of personal interests.” This expression was entwined in a system of incentive and privilege that aimed at keeping the convicts more or less happy. Even fire-fighting (for which the convicts were responsible) succumbed to the logic of Lawes’s managerialism. As he wrote, “There is a keen rivalry between the different fire companies and positions on the fire department are frequently given as rewards of merit.” So, too, the death of a prisoner (by natural or other causes) became an occasion for boosting the morale of other prisoners: “When a fellow dies,” Lawes informed an audience at the New School for Social Research in 1931, “whatever his religious belief was, or if he had any, or if he hadn’t, whatever his belief was, it is respected. I don’t know if that helps a fellow that is dead any, but I think it helps the fellows who are left behind” (emphasis added).

Notably, Lawes rarely mentioned the new penological objective of restoring convicts to citizenship. Indeed, he frequently argued that crime originated in the structures and pathologies of modern industrial society itself, and would be eliminated only once those structures were themselves changed. As he saw it, “(u)nder our present social order prisons are a necessary evil.” For Lawes, unlike Osborne and the new penologists, the chief task of prison administration was not to “cure” criminals or deter crime; it was to maintain the peace and security of the prison, both within the institution’s walls and outside, in the large sphere of penal politics.

Although most, if not all, the disciplinary techniques found in Sing Sing and the other New York prisons in the 1920s owed their origins to the progressives, those techniques were being put to different uses and were taking on very different meanings than the ones progressives had intended. At Sing Sing, the enlightened “republic of convicts” became a bargaining table across which prisoners and administrators hashed out a “square deal;” the goal of making good prisoners of convicts usurped that of restoring convicts to manly worker-citizenship. The lament of one new penological investigator, in 1924, was typical:

The emphasis today is laid on the gaining of privileges as a reward for conduct rather than in stimulating the sense of individual responsibility for the common welfare, which is the basis of good citizenship. In one case the privileges are used as a (sic) end in themselves; in the other, merely as the means to a very different, and far greater end.

The disappointed observer concluded that the warden “uses the League chiefly to serve the prison administration rather than uses both the League and Administration to serve society.” Although rehabilitation remained a formal objective of imprisonment, “morale-making” was the guiding principle of the new system. Although both the new penologists and the administrators of the 1920s aimed to produce a prison order in which the convict turned outwards from his self, his soul, or his morbid unconscious and became absorbed in activities that sublimated his mental and physical energies, the new penologists had subordinated those techniques to the overriding objective of socializing prisoners as self-disciplined worker–citizens. After the war, conversely, New York’s prison wardens consistently reiterated that imprisonment’s principal task was essentially managerial in nature: The administrator’s job was to maintain what Lawes referred to as the “morale of the domain” and he was to achieve this by establishing various activities that sublimated the passions and desires of the prisoners.

The morale of the domain depended upon prisoners and keepers entering a double relationship of exchange. On the one hand, prisoners exchanged their good behavior for “good-time”: That is, if they behaved well, they would regain their liberty sooner. In the meantime, they also traded obedience for the gratifying privileges of attending (or playing in) convict baseball matches, watching movies, making use of psychiatric counseling services, and purchasing tobacco and other small pleasures from the prison commissary. Radio, cinema, recreational activities, athletics, access to a well-stocked grocery, and therapy were all part of one pervasively psychological penal order of sublimation. These various activities were comforting commodities to be purchased with the only hard currency a prisoner possessed: obedience. Lawes did not hesitate to plainly state this point: “Naturally the convicts have to pay some price for the possession of such a cherished bounty. The asking price is a matter of obedience.” At Sing Sing, in particular, but to a significant degree in Auburn and Clinton as well, prison order came to rest on a more or less tacit agreement between prisoner and keeper that the former could purchase some measure of pleasure from the latter by resisting the urge to cause trouble. Morale-building, as a technique of maintaining peaceful institutions, took the place of moral reform.

Within a few years of arriving at Sing Sing, Lawes had completed the transformation of the original new penological project into a new, managerialist penal order. Although elements of this penal managerialism could be found in other New York prisons (and in a number of other states, including Texas, Minnesota, Illinois, and California), nowhere was it as fully and systematically developed as at Sing Sing. In the few years either side of 1930, three separate, though related, strings of events – the Baumes laws, prison riots at Auburn and Clinton prison (but not at Sing Sing) and federal regulation of prison labour - would propel Lawes’s system to national notice and reinforce the relevance and utility of penal managerialism."

- Rebecca M. McLennan, The Crisis of Imprisonment: Protest, Politics, and the Making of the American Penal State, 1776-1941. Cambridge University Press, 2008. McCormick, p. 443-449.

The photo shows an officer instructing a Sing Sing prisoner on bed-making, from Lewis E. Lawes, Twenty Thousand Years in Sing Sing.  New York: A. L. Burt Company, 1932, p. 176.

do you have like an antipsych masterpost or reading list? ive been meaning to get more people into it but dont know where to start

Here's a short reading list I made last week, including a link to a much longer reading list (The anti-psychiatry bibliography and resource guide) broken down by category ("the mental patient experience," "the politics of sanity and madness," "psychiatry and the law," "psychiatry and women," "alternatives to institutional psychiatry," &c.).

The bibliography and resource guide also includes brief passages that elucidate the history of anti-psych movements, as well as summaries of particular thinkers' views. This article provides a quick rundown of some of the people and movements that coalesced under the banner of "antipsychiatry."

In terms of antipsychiatry as a 'field', David Cooper's works are seminal. R. D. Laing is also influential, though he considered himself an advocator for psychiatric reform (and would also go on to collaborate with the Church of Scientology, under an "enemy of my enemy" principle).

For shorter readings from the perspective of a patient, I'd recommend Wren Ave's blog.

This post (based on this one) was my attempt at an "introduction" to the topic of antipsychiatry.

Basically, I'd recommend finding a topic that interests you (the history of psychiatry? patients' testimonies? underlying logics of pathologisation?) and then find something in the anti-psych bibliography that sounds promising. Anti-psych has quite a few different "prongs" to it and it's best to start out with a topic you feel drawn to.

Fuck it my blog is pro-psych, just pro-reform.

Psych Critical if you will.

I am quite literally fucking exhausted by the amounts of (typically low support needs) NDs who go around talking about how there should be "no more psychiatry" and "no more psychology" and we should "abolish the DSM" and "abolish psychiatric/psychological care". How about actually- fuck you? How about that because you want me to fucking die- you want to kill off NDs with higher support needs who rely on doctors to be able to stay alive and not be in danger.

No I don't want to abolish psychiatry because not only do I need my medications but I am logistically opposed to people just randomly being able to get whatever medication they want because they self diagnosed themselves with something. If you haven't taken a psychiatric med you had a horrible reaction to- you're lucky, If you have the wrong combination or take one your personal body doesn't like you can experience psychosis, suicidal ideation, homicidal ideation, dizziness, drowsiness, nausea, hallucination based psychosis, etc. No the public should not get to dictate what medication they get because people are not educated enough to know if they will cause adverse effects when mixed.

No I don't want to abolish psychology just because one of our past therapists abused us and groomed us as a kid. Sometimes bad people are in places of power. Our good therapists have helped us immensely. Our life has improved drastically since we've been seeing a specific therapist for our DID. We've been able to function better we've been able to feel some happiness in the midst of the horrific memories we have uncovered.

I think all this healthcare should continue. I think however it should be free- and it should be possible and easy for even minors to refuse certain types of treatment if they personally want. However anti-psych seeks not to reform the issues- but to destroy the support networks so many rely on. It is not about people's freedom to choose- it is about forcing others out of a system that may very well be the only thing keeping them going.