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Friday, September 3, 2010

Book review: Calling out for mad liberation - "On our own: patient-controlled alternatives to mental health" (2009)

From Slingshot issue 101

By Samantha

This article is the last article written by our friend Samantha (see obituary p. 4) On Our Own is a classic anti-psychiatry text that has had a significant impact on radical mental health.

On Our Own: Patient-Controlled Alternatives to the Mental Health

By Judi Chamberlin

Hawthorne Books, New York 1978.

Judi Chamberlin travels a tumbling path towards the title of her book, through her own experience of the mental health system towards her ideal goal of patients helping each other to keep themselves together. She outlines the problems faced by mental patients and she beats a tinny improvised drum calling out for mad liberation through consciousness-raising.

Chamberlin's focus on patient- controlled alternatives will strike a resonating note with brave readers who hold high the banner of direct democracy or seek to level the power of authority figures. She even discards the radical theorist R.D. Laing, for continuing a distinction between "healers and healed" in his writings and anti-psychiatry experiments based on them. The intensity of her railing against this distinction may seem arbitrary and extreme without considering the viewpoint of mental patients being treated, usually involuntarily, for conditions in their own minds. The patient faces an isolation not imposed on sufferers of other illnesses, at a time when human companionship may be the only alleviating factor.

The isolation can continue long after the patient is declared "cured," and a hospital stay or mental disability discharge carries a stigma in looking for jobs, lovers, or friends. Judi goes to great length to show how the discrepancy in power between the psychiatrist and patient remains immense, and unjustified. Danger of harming self or others is legal criteria for involuntary commitment and a patient can be held in custody with only the psychiatrist as a witness of her motives, but the psychiatrist has no more ability to see human intentions to commit acts of violence or self destruction than anyone else. Confronting this authority and dismantling this false expertise lies at the heart of reaching freedom. Judi Chamberlin stays true to this goal and remains extremely vigilant in dealing with any experts who place themselves higher than the patient.

The chapter dedicated to Judi's own experience with psychiatrists and hospitalization provides her credentials as an ex-patient seeking to raise consciousness and help other patients get by, as well as giving readers a straightforward account of a psychiatric survivor. I empathized with her years of anguish in and out of hospitals, and I was impressed that she described in simple terms the humiliations she experienced as inherent in the hospital system, rather than depending on excesses and abuses. Whether in a 'cottage' or a locked ward, group therapy or isolation, Judi comes to fear and hate the physical control inherent in the system.

It is fascinating to me that she sought treatment out between stays, finding the experience of living outside the hospital system with family or a shitty husband unbearable. This is a fact seldom admitted in an exposé of the mental health system, and I find it courageous to be able to admit that you can't deal with everyday life on your own.

A turning point in her view of the system occurs when she becomes extremely miserable after a mental hospital discontinues her tranquilizers upon admission, and she experiences a variety of physical and mental withdrawal symptoms, such as a churning stomach, dizziness, crawling flesh, anger, and frustration. Another patient tells her she is probably undergoing withdrawal from the medications she was prescribed by her doctor, which had previously not affected her. A light turns on in Judi's head, as another patient has offered her an unexpected insight into her condition: "I got my first 'therapy' at Hillside under that tree, and it came from another patient." Instead of a "relapse" into mental illness, the absence of the previously ineffective drugs produces new symptoms. Withdrawal from psychiatric drugs is a viewpoint I have never heard from a doctor, and I have recently only come across when a friend mailed me the Icarus Project and Freedom Center's Harm Reduction Guide to Coming Off Psychiatric Drugs. But patients have been sharing this knowledge since psych drugs became prevalent in the 1950s, and it helps clarify some experiences in my own life.

Judi's experiences with the Vancouver Emotional Emergency Center will probably seem familiar to anyone lucky enough to turn to a close circle of compassionate people who have had similar experiences. Strangers or old friends, they do their best to patch together what is needed and listen, and offer relief from the mind games and deceit. The "unmaking of a mental patient" happens as she realizes there are other ways to get the human help she needs and a new life opens up to her. We imagine her able to say the word crazy with a wild grin of abandon and laugh, and Judi is now able to pose a new question: how can others systematically receive the help they actually need?

Judi gets down to business and explores organizations operated by the mad for the mad, working for mental patient's liberation. She explores the many difficulties ex-patients face because of bias, rather than any danger to themselves. She covers many of the details of various organizations' daily work, highs and lows, including a whole chapter on funding. She describes groups working both in crises situations, like the Vancouver Emergency Center, and on the long term problems faced by ex-patients, such as Project Release in New York and the Mental Patients Association in Vancouver. She compares the shoestring collectives with a potent "conscious" analysis gained through long discussions, to organizations better funded with a more confused relationship to the system. I was fascinated that many of the groups emphasized ex-patient housing, and a little dazzled that a group of mental patients on welfare in 1978 could pick up cheap city apartments. A goal now that would be classified as dreamy seemed bluntly practical to Judi Chamberlin.

Thirty years have passed since the publication of this book. There are many experiences that date both Chamberlin's direct experience of hospitalization and the alternatives she discusses: the thorazine "concentrate" and the Great Society War On Poverty funding for community projects are both things of the past. Yet there is a striking skeleton of her work that is easy to recognize, fleshed out in this society. Current drug regiments still focus more heavily on tranquilizing and sedating patients, with only mixed results for actually alleviating unpleasant symptoms. Likewise, confinement and physical force continue to hide behind the guise of treatment. Some of the innovations or alternatives shot down in the book now are mainstays of treatment: community mental health centers are at the core of most outpatient treatment, and a lot of us grew up sleeping through various psychotherapy snore sessions first introduced in the 1960s.

One weakness of the book is the way it lumps mental patients together in a broad mass, without addressing the distinctions between what mental patients experience because of their individual identities. Her vision of liberation is broadly based on a feminist model, but little attention is paid in this work to differences in organizations and institutions caused by race, class, gender, and sexuality. While this broad topic may be beyond the range of this book, the reader is left with the impression of mental patients seeking liberation as predominantly white and middle class. The horrors of the eugenics movement make it imperative to acknowledge the dirty work done by the psychiatrist on poor women and women of color, and any serious attempt at mad liberation must integrate this analysis.

As I reflect on my own experience, Judi's does seem to minimize certain ambiguities. Can patients always solve each other's problems? Is there really no useful role for well-intentioned professionals? There are times when a little tranquilizer might give me the sleep I need to keep from being a pathetic nervous wreck and there are times when other patients provide advice that is not helpful.

On the other hand fear and hostility towards professional psychiatrists is a gut reaction based on real problems, and although psychiatry is constantly toting its reforms, restraints, isolation, and even electroshock are features of most hospitals, and most patients have felt the breath of fresh air another patient's honesty can bring. I am impressed that Judi presents these views so forcefully.

On Our Own could end up on the tables of many people asking the same questions as Judi Chamberlin. How to get out of a depressing anguish? How to work together to provide some relief when we our troubled? How do we keep vulnerable people safe from psychiatric abuse? Judi provides few solid answers, but her unshaken faith in our ability to provide those answers to each other is an inspiration.

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