Radical Psychology
2006, Volume Five


Psychiatric Survivor Testimonials and Embodiment:

Emotional Challenges to Medical Knowledge

Christopher Canning

Abstract


Since the early 1990s, techniques and technologies for studying neurological and genetic causes of psychiatric illness have increased rapidly, during which time bio-medicines have (re)defined the relationship between personhood, the brain, body, and illness. Working within a sociological and geographical analysis of embodiment and mental health, the paper explores how emotions – forming from and emerging within psychiatric survivor testimonials – challenge scientific knowledge as the trump card to felt experiences. The paper draws on the work of R.D. Laing, Michel Foucault, and anti-psychiatry literature to provide a social study of psychiatry, a position that promotes embodied testimony as one avenue for the politicization of a psychiatrized situated knowledge.


Key Words: Anti-psychiatry, psychiatric survivor testimony, situated knowledge, identity, sociology and geography of emotion


Introduction


The study of emotions…provides an expanded understanding of the place of bodily agency in society, linking as it does the somatic and communicative aspects of being in the world, and thus the bodily, social, and cultural domains (Williams and Bendelow, 1998, p. 154).


Influenced in large part by the post-modern and/or post-structuralist challenge to the rational subject (Foucault, 1976; Deleuze and Guattari, 1987; Haraway, 2004; May, 2005), many sociological and geographical studies now recognize how bodies and emotions are shaped by and help shape experiences and being(s)-in-the-world (Laing, 1960; Laing, 1967; Freund, 1990; Williams and Bendelow, 1998; Davidson and Milligan, 2004; Davidson et al., 2005). Embodied experiences are important for many reasons, and their theoretical, epistemological, and ontological significance has been studied in sociology (Freund, 1990; Williams and Bendelow, 1998; Williams, 2000), feminist theory (Haraway, 2004), cultural studies (Butler, 1990), geography (Valentine, 1998; Knopp, 2004; Davidson et al., 2005), and more importantly for the theme of this paper, mental health studies (Shimrat, 1997; Parr, 2000; Burstow, 2004; Philo, 2005).


In this paper, I will demonstrate how mental health policy in Canada often presents a purely rational, scientific terrain of knowledge, an approach that manages only a cursory mention of the daily lives of psychiatric survivors. [1] The paper will discuss how psychiatric survivor testimonials can be promoted as politicized challenges to the medical model of biological psychiatry, a field that largely dominates how mental health services are defined and delivered in Canada. [2] Working within a sociological and geographical analysis of mental health, this paper will elucidate how feelings and emotions – forming from and emerging within testimonials – challenge scientific knowledge as the trump card to felt experiences (Burstow and Weitz, 1988; Parr, 2000; Burstow, 2004; Cresswell, 2005). Psychiatric survivor testimonials will be contextualized geographically by exposing how survivors negotiate the world in ‘de-institutionalized spaces,' through which the ‘mentally ill' are supposedly free from confinement (Parr, 2000; Philo, 2005; Burstow, 2004). Personal, and often painful, testimonies are one way of challenging biological and clinical diagnosis, which rarely offer access to the emotional world of the individuals scientific studies are said to describe (Burstow and Weitz, 1988; Shimrat, 1997). Adding to what many theorists have said about the existential world of the ‘patient,' especially as they are situated in a social and political world of ‘others,' this paper concludes with a brief discussion of how exposing survivor-led, embodied experiences help politicize a ‘situated knowledge,' an important (non-science) expert position within the broader ‘psychiatric survivor' social movement (Haraway, 2005; Laing, 1961; Burstow and Weitz, 1988; Kotowicz, 1997; Crossley, 1998; Burstow, 2004; Day, 2006).


The Rational and Scientific World of Mental Health Policy: Pathologizing Emotion(s)


Although the fundamental disease process seems not to be directly altered by psychosurgical procedure [lobotomy], the patient is relieved of abnormal emotion attached to morbid ideas, and his [sic] attention can be diverted to more realistic concepts and more constructive activities (Burlingame, 1949, p. 141).


Two [theorists] contributed to the mythology surrounding schizophrenia. The American psychoanalyst Thomas Szasz pronounced that schizophrenia, like other mental illnesses, is a set of behaviors, not a disease. The late R.D. Laing, a British psychiatrist, suggested that it is really a ‘healthy' response to an ‘insane' world. People burdened with terrible stress act ‘crazy' in an effort to adapt. Scientific research and factual data have discredited these theories. Unfortunately, they were all popular enough at one time to have gained public attention (Schizophrenia: A Handbook for Families, 1991, p. 5). [3]


This section will offer a brief overview of scientific literature and Canadian governmental policies, two fields of knowledge within which mental illnesses are defined. I will highlight how biological psychiatry pathologizes emotion [4] and commonly ignores how bodies are shaped by scientific knowledge that has historically objectified the lived experiences of psychiatric survivors. Although the science of mental health is very important and extremely interesting, this paper will, unfortunately, only be able to offer a brief reading of the scientific literature.


In this section I would like to highlight two main threads that are important for studies in mental health: 1) I do not deny that our bodies are shaped, in part, by physiology, including neurological and biological traits that continue to be investigated by respected scientists; 2) I do, however, challenge the scientific landscape that manages only a perfunctory mention of how emotions, experiences, and bodies are bound up in a rational/scientific terrain, especially as the social, political, economic, and normative world goes largely unchallenged within mainstream forms of psychiatric knowledge. The second aspect is of particular interest, as purely neurological or biological interpretations of mental illness largely ignore felt experiences and emotions as they shape and are shaped by one's embodied experiences with ill mental health (Laing, 1961, Cooper, 1967, Parr, 2000).


Mental illness is commonly conceived of as a negative effect of abnormal physiological traits. The idea that mental illness is shaped by neurological processes with biological origins is certainly not a new one – the dispute was important when lobotomy was a popular treatment in the 1940s and 1950s (Valenstein, 1986). More contemporary neurological studies have been able to isolate regions of the brain that shape or influence symptoms of mental illnesses. However, how to define, classify or treat symptoms of mental illness, whether neuro-chemical or neuro-genetic, is still very much disputed (Breggin, 1994; Cohen, 1988).


In more contemporary literature, schizophrenia is frequently referred to as a ‘shattered' personality, a condition that involves disturbances of the brain's chemistry, anatomic features, and physiology (Maxmen and Ward, 1995; McGuffin, 2005). Schizophrenia, in short, is said to be a distortion of perception and subjective experiences. Neuroscientists are currently examining genetic origins of mental illness (McGuffin, 2005), and how the ‘disease' can be located before it flourishes. Genetic and biological factors are believed to be the root cause of the illness, factors which are often compounded by particular psychosocial influences. According to some scientific literature, however, genes and neurobiological substrates are also shaped by environmental influences, but precisely what ‘environmental' means is ambiguous and often deterministic (Hedaya, 1996; McGuffin, 2005). Nicholas Rose is now calling the study of genetic origins of mental illness the ‘sociology of susceptibility' (Rose, 2006), especially as governmental agencies are working with pharmaceutical corporations to track and treat individual citizens.


Etiological theories, reflected in governmental policies on mental health, which I will discuss shortly, are based on genetic and neurochemical causes. Children with one schizophrenic parent are ten to sixteen percent more likely to develop schizophrenia, whereas the general public has a likelihood of one percent (Maxmen and Ward, 1995, p. 184). Neurochemical influences are caused by "metabolic under activity of the frontal lobe that decreases activity in the basal ganglia" (Maxmen and Ward, 1995, p. 184), which highlights differences in the nervous system causing sensory information to be processed abnormally. Such disturbances are said to cause impairment of attention and interactive abilities. While much of the literature is dedicated to psychopathological, neurological, and biological origins of the ‘disease,' psychosocial theories receive only a brief mention. Such explanations often include intrapsychic influences – or what has been ‘done' to the patient to ‘cause' the disease – and vulnerability – or what ‘stress' has triggered the development of the illness or disease. A main theme, regardless of the etiology, depends on the term schizophrenia, coined by Eugen Bleuler, that often denotes a ‘shattered' personality. That is, whereas ‘"patients with other severe mental disorders may have one or perhaps two symptoms of schizophrenia, the curse of the schizophrenic is to be plagued by most of them" (Maxmen and Ward, 1995, p. 173). Suffice it to note here that, building upon the historical categorization by Blueler, the schizophrenic self is not only diseased, but also unable to process her or his thoughts/feelings as a result of ‘affect' disturbances. While I would never deny the challenges faced by individuals with symptoms of schizophrenia, I find it also important to note how the pathology of the ‘disease' automatically categorizes symptoms as necessarily an impairment of themselves in the social world.


Reflected in the Public Health Agency of Canada (PHAC) policy document: Schizophrenia: A Handbook for Families (1991), the ‘diseased' self is unable to have access to her or his own world. The document is one of three available on the PHAC website for anyone interested in knowing more about the etiology of schizophrenia, symptoms of behavior, stigma attached to being labeled, forms of treatment, and ways of ‘dealing' with individuals with schizophrenia. While it would be difficult to fairly and adequately summarize the document in this paper, I would like to highlight how schizophrenia is defined. This section tends to automatically exclude or intentionally ignore how women and men with schizophrenia may, at times, be able to understand their own world better than scientific ‘experts.' This exclusion is not to deny that science can explain certain aspects of behavior, rather that etiological theories are often deterministic in their assumptions that genetic or biological factors automatically means that people with schizophrenia cannot know her or his own world.


Schizophrenia: A Handbook for Families defines schizophrenia as a neurological disease, basing its justification upon biological psychiatry's broad definition of mental illness: "the current evidence concerning the cause of schizophrenia is a mosaic…these [factors] include changes in the chemistry of the brain, changes in the structure of the brain, and genetic factors" (1991, p. 2). Although the document acknowledges that there are multiple factors for such a complex ‘disease,' this complexity is reduced to a single (tautological) definition: "schizophrenia is probably a group of related diseases, some of which are caused by one factor and some by another" (1991, p. 2). The document remains ambiguous in its definition of schizophrenia, certainly a result of the vagueness of the etiology. In other words, while the etiology is based upon multiple factors, the multiplicity of the origins are narrowed to a single point that defines schizophrenia as a single disease and an "altered sense of self" (1991, p. 3). The symptoms of the ‘illness,' of ambiguous etiology, rely on external patterns of behavior to classify an internal disease, resulting in a self that cannot, by definition, know itself.


For instance, the document defines the altered sense of self as a positive symptom of schizophrenia, a disease that "is a blurring of the ill person's feelings of who he or she is. It may be a sensation of being bodiless, or non-existent as a person. The ill individual may not be able to tell where her or his body stops and the rest of the world begins. It may be as if the body is separated from the person" (1991, p. 4). Of particular interest is how the policy document always already excludes the possibility of an ‘ill' person to know his- or herself; the ‘diseased,' ‘bodiless' brain is always an object of medical diagnosis and treatment.


Another common pathologized symptom of schizophrenia, which will be challenged in the following section, is what The Handbook describes as ‘blunted feelings' or ‘blunted affect' (1991, p. 4). So-called ‘blunted affect,' reflected in the DSM-IV, is the ‘flattening of emotions':


Because facial expressions and hand gestures may be limited or nonexistent, the ill individual seems unable to feel or show any emotion at all. This does not mean that the individual does not feel emotions and is not receptive to kindness and consideration. He or she may be feeling very emotional but cannot express it outwardly. Blunted affect may become a stronger symptom as the disease progresses (1991, p. 4).


While the document acknowledges that people diagnosed with schizophrenia have the ability to be emotional, the fact that this document denies that people with schizophrenia understand and derive meaning from emotions is of particular interest. Peter Breggin (1994) argues that simply because patients do not show emotions, or seem resistant or docile, does not necessarily make them ill or diseased. He argues that instead of seeing emotion as a symptom of an illness, can emotion (blunted or not) be seen as a response to the system of psychiatry, rather than as a classifiable symptom of a disease in the brain?

Emotions and Embodiment: The Politics of Voice and Survivor Testimonials


It is this circle that anti-psychiatry undertakes to undo: giving the individual the right to take his [sic] madness to the limit, to see it through, in an experience to which others may contribute, but never in the name of power that would be conferred on them by their reason or normality; detaching the behaviors, the suffering, the desires from the medical status that had been conferred on them, freeing them from a diagnosis and a symptomatology that had not simply a value of classification but also one of decision and decree (Foucault, in Psychiatric Power, 1994, p. 49).


Schizophrenia needs to be defined in positive terms. ‘Dissociation,' ‘autism,' and ‘loss of reality' are convenient terms for those who wish to silence schizophrenics...‘loss of reality' – how can we say this about someone who lives in an almost unbearable proximity to the real (‘this emotion, which communicates to the mind the shattering sound of matter,' writes Artaud in the Nerve Meter)? (Deleuze, 2006, p. 27).

Rather than psychiatry, why not the schizophrenics, the crazies themselves? It seems to me that those who work in the field of psychiatry, at least right now, are hardly on the cutting edge! (Felix Guattari, as cited in Deleuze, 2004, p. 237).


For embodied knowledge to matter, it is important to understand that women and men living as ‘mentally ill' [5] are, in part, experts of their own world, one that scientific knowledge can only partially explain. An embodied, situated knowledge is about the telling of stories at a particular point in time from a particular – often oppressed – position. As healing and good mental health have been commodified, individualized, and characterized within the mind/body distinction, embodied knowledge, conversely, challenges the political, economic, and social conditions in which one experiences mental illness through the body. [6] This method does not suggest that experiences of illness can expose an essential category that can be used to define a single identity, nor that a ‘truer' healthy self can be set free in later stages of material conditions or discursive practices. [7] On the contrary, because emotions have historically been pathologized, the political force of situated knowledge exists in the ability to contextualize, emotionally, the field of knowledge and material living conditions psychiatric survivors roam daily. That is, situated knowledge – defined through testimony – can be seen as the interplay between space and emotion invoked by and within different social spaces. Our access to ‘the world' is never impartial; embodiment affects the outcome of our interaction in and of the world. Hester Parr (2000) refers to embodiment as a fluid state of being, but does not deny that bodies negotiate dominant constructions of differences defined by psychiatric knowledge. Understanding emotions, therefore, helps us to situate the social geographies that many people with mental health problems live out on a daily basis.


Emotions are important for an embodied knowledge, as Freund has argued, because the way one feels is always linked to material and social conditions. This relationship highlights "different modes of emotional being [that] are, in effect, different felt ways of feeling empowered and disempowered" (Freund, as cited in Williams and Bendelow, 1998, p. 143). Testimonial responses to psychiatry acknowledge a particular agency within the act of speaking, which necessarily links emotion and bodily being(s)-in-the-world with social relations. Such a relationship to the world is always felt and emotionally embodied (Williams and Bendelow, 1998).


Gill Valentine, who writes in the area of emotional geographies, argues that personal testimony should be promoted in the social sciences. Testimonies aid in interpreting situated and felt responses to social and cultural forms of oppression. In her article Sticks and Stones, Valentine (1998) recounts her experiences of overt and violent acts of homophobia within academia.[8] By using her own testimonials to make explicit the embodied and situated nature of knowledge, her powerful narration of the material events of everyday life exemplifies the need to understand how violence is shaped in and through the spaces of academia. In this particular paper, Valentine uses her own experiences to outline an emotional and embodied geography of what it means to be harassed, particularly relevant within the post-modern concern with difference that has highlighted a need to understand ‘othered' voices (see also Day, 2006). The importance of personal testimony, therefore, is its methodological and theoretical influence on the situated (embodied) nature of our knowledge. Situated knowledge attaches the author or speaker to the embodied experience, which highlights often painful, traumatic, and destructive forms of harassment, be it homophobic, psychiatric, or intersecting forms of oppression.


Further to this, Davidson and Miligan highlight that an understanding of mental illness "[Acknowledges] the important place of emotions when it comes to conceptualizing and faithfully re-presenting subjects' experiences" (2004, p. 525). R.D. Laing and Esterson support this claim in their existential challenge to the clinical model of diagnosis and treatment:


We are concerned with persons, the relations between persons…each person not only is an object in the world of others but is a position in space and time from which he [sic] experiences, constitutes, and acts in his world. He is his own centre with his own point of view, and it is precisely each person's perspective on the situation that he shares with others that we wish to discover (Laing and Esterson, 1964, p. 19).


While to ‘discover' individual perspectives should not occupy a single or true definition of experience, survivor testimonials elucidate and challenge how bodies are objects of biological analysis and clinical diagnosis. Promoting emotional responses to the mental health world can create new ways of understanding, feeling, and interpreting the meaning of illness as embodied subjects (Foucault, 1961; Laing and Esterson, 1964; Cooper, 1978; Parr, 2000; Philo, 2005).


Mark Cresswell (2005) succinctly summarizes why testimony is a productive feature of resistance to the power of modern-day psychiatry. [9] He outlines the distinction between patients and survivors of psychiatry, the latter representing individuals who have survived a supposedly helping system. Ironically, or intentionally as one part of a liberal-democratic state and privatized pharmaceutical industry, the psychiatric system often works to oppress and/or highlight existing inequalities without addressing the social, cultural, and economic factors that lead to and perpetuate marginalization in our society (Burstow, 2004). While many would argue that the psychiatric system is a helping one, which to some extent it is, testimony, conversely, offers multiple ways for the ‘mentally ill' to speak their minds; speaking her or his mind is always already happening, but not often heard. Bonnie Burstow highlights this silence in the context of the over-represented medical expert and/or clinician's voice. Therapeutic hegemony operates such that "the opinions of survivors are generally under-represented and often downright dismissed" (Burstow, 2004, p. 149). Friedenberg furthers Burstow's point that conventional psychiatry and psychoanalysis treat patients assuming they are hampered by defects in their perceptions of their own reality:


. . . [Reality] is conceived as external to [survivors] – as something they must be led to see more clearly and deal with more effectively. The seriousness of the patient's illness is to be judged by the depth and extent of the discrepancy between his [sic] subjective view of his life situation and the objective correct assessment (Friedenburg,1973, p. 61).


Conventional forms of biological psychiatry and psychoanalytical theories, according to much of Laing's philosophy, perpetuate the notion that the inner self, the speaking subject, is not able to share itself with a world that is perceived to be more accurately interpreted by medical professionals. Laing suggests:


A feature of the interplay between psychiatrist and patient is that if the patient's part is taken out context, as is done in the clinical description, it might seem very odd. The psychiatrist's part, however, is taken as the very touchstone for our common-sense view of normality. The psychiatrist, as ipso facto sane, shows that the patient is out of contact with him [sic]. The fact that he is out of contact with the patient shows that there is something wrong with the patient, but not with the psychiatrist (1967, p. 89 – 90, italics in original).


Conversely, speaking from a particular subject position – be it schizophrenic or a survivor of multiple forms of psychiatric oppression – means creating a politics of self-advocacy: "Psychiatrists have paid very little attention to the experience of the patient. Even in psychoanalysis there is an abiding tendency to suppose that the schizophrenic's experiences are somehow unreal or invalid" (Laing, 1967, p. 90). Self-advocacy through testimony, therefore, can be defined as an expression that is not only uttered, but is an action that runs across and emerges from experience (Cooper, 1978). Rather than seeing ‘patients' as helpless consumers of a health care system that serves, testimony becomes an embodied engagement with the system itself; survivors themselves organize and lead the planning, delivery, and focus of getting through her or his own suffering (Burstow, 2004). [10] This does not mean that recovery happens alone. [11] Burstow has further argued that recognizing suffering happens through the creation of ethically and politically aligned networks of survivors, advocates, and progressive mental health care professionals (see also Breggin, 1994). Recognizing the need for a space in which testimonies can be heard is simply the beginning.


Through psychiatric survivor testimonials, an embodied, emotional knowledge is defined by and how a survivor has witnessed and experienced harms associated with the psychiatric system (Cresswell, 2005). However, according to Cresswell, testimony can take two forms: 1) negative experiences of the mental health world, through which will emerge emotional and situated responses to legends of oppression; and 2) positive alternatives to experience demonstrates how survivors are in effect experts, even more so than medical professionals (Cresswell, 2005; see also Burstow and Weitz, 1988; Shimrat, 1997). Advocating for a space in which testimonials can emerge, survivors can be recognized as experts by experience as psychiatric survivors, not objects of clinical practices. An embodied experience can reveal countless ways in which situated knowledge equals a claim to expertise about ‘being ill.' Embodied knowledge necessarily adds to the on-going critiques that emotion and other mental illnesses are always a biological disease (Burstow, 2004; Cresswell, 2005).


In order to challenge the hegemonic function of psychiatry, Cresswell (2005) argues, testimony can be enacted as a ‘truth-claim,' a process through which survivors bring into being current, embodied ‘state of affairs,' rather than report past or present occurrences. Cresswell defines psychiatric hegemony as the political process by which dominant forms of medical knowledge work to produce subjects within a broader normative order. As a political performance of surviving, "testimony is a ritual discourse in which the speaking, suffering subject is also the subject of the statement; and in which the suffering of which she speaks is inscribed by herself upon or within her body" (2005, p. 1674). Testimonies, enacted as counter-hegemonic, support the critiques of psychiatry and the practices of self-advocacy and self-determination, and expose countless ways of how, within power relations, survivors have been denied access to their own world (Laing, 1960; Cooper, 1978).


Bonnie Burstow and Irit Shimrat, in a Canadian context, continue to advocate for an embodied understanding of institutionalized and medicalized identities, especially in that personal experience has largely been violated in the psychiatric system (Burstow and Wietz, 1988; Parr, 2000). Irit Shimrat's book Call Me Crazy (1997) is largely dedicated to the topic of how psychiatrized others have been violated, among other things, in and by the psychiatric system. The book can easily be characterized as a space and place for testimonies to emerge and be heard.


Testimonies are important for a politics of voice and for the construction and maintenance of psychiatric survivor communities (Shimrat, 1997; Burstow, 2004). While survivor communities are not monolithic, and many intersecting oppressions such as race, class, ability, and gender continue to complicate our understanding of community, testimonies become a form of speaking from the locus of the psychiatrized suffering self. Mark Cresswell refers to this as knowledge forged from the direct experience of surviving (2005). Hester Parr (2000) takes a similar position in her studies of mental illness in post-asylum landscapes, similar in analysis to Burstow's work on de-institutionalized spaces (Parr, 2000; Burstow, 2004). Parr's analysis breaks down assumptions that ‘communities' of survivors are monolithic, loving spaces free of stigma and encoded knowledge, and is important for complicating and unpacking what she calls geographies of exclusion (2000). The main theoretical force of her work is how she questions our understanding of sameness and difference for studies in emotional geography. While communities allow ‘mad' behavior to exist in different ways, there are certain norms and boundaries maintained by larger social, cultural, and material levels of acceptability. Just because we have ‘de-institutionalized' spaces for the ‘caring' of the mentally ill, does not mean that stigma and cultural understandings of difference do not still perpetuate social and bodily (acceptable) boundaries.


Vanessa Pinfold (2000) similarly argues that personalized, emotional perspectives of mental health can contribute to an understanding of the journeys that are traveled in community care facilities in the UK and beyond. She argues that giving voice is an important concept when working with (and hearing) psychiatric survivors. Although she prefers consumer to survivor, a distinction that needs much more unpacking, Pinfold highlights how the voices of those suffering have been censored within dominant, scientific forms of knowledge. To challenge dominant forms of knowledge, voices of survivors offer new interpretations of what it means to be ill (see also Davidson, 2003). Self-determination does not endorse the biological model of mental illness, but counter-poses the hegemonic function of medical science with the lived and emotional reality of survivors – as they are defined and produced as objects of medical knowledge (Cresswell, 2005).


Bonnie Burstow (2004) has written extensively since the 1980s about why a shared critique of institutional psychiatry is important. While etiologies of mental illness range from biological, neurological, and/or psychoanalytical origins, a shared critique of psychiatry opens up a space for what Burstow calls the psychiatrized ‘other' to speak for self-determination. Speaking from a psychiatrized other position is often full of pain, alienation, suffering, and loneliness – but can at times be very joyful as well (Porter, 1985). It is precisely that traditional forms of psychiatric diagnosis and treatment – especially within the biological model – have been incompatible with emotion, however, that makes the act of speaking against psychiatry so powerful. In order to make such claims to situated self-determination more powerful and politically forceful, Burstow has allied herself with progressive medical professionals in the mental health field. For instance, Peter Breggin and David Cohen, whose work I will return to shortly, have joined the psychiatric survivor movement in order to demand survivor self-actualization and self-determination, a goal largely at the heart of testimony and the politics of voice (Burstow, 2004). Joining the survivor movement does not mean speaking for survivors. Rather, joining the movement means understanding that survivors have more to say than has historically been heard.


A main feature of the disciplinary/controlling features of psychiatric knowledge can be summed up by what Nicholas Rose has referred to as the "expertise of subjectivity" (as cited in Lupton, 1998, p. 93). Within dominant forms of medical knowledge, emotion has always been considered an aspect of the ‘sick self' that needs improvement – that is, emotion is pathologized within psychology, psychiatry, social work, and more recently, neurobiologies. Within psychoanalytical forms of therapy, talking about experience is often reduced to the removal of emotions, or coming to terms with how best to manage emotions: "the discourses of humanistic psychology and psychoanalysis . . . have had an increasing influence on the ways in which self and the emotions are conceptualized in late modern societies" (Lupton, 1998, p. 93). Conversely, testimony, or providing a space to discuss embodied responses to psychiatry, does not pathologize emotions, but promotes the need to live them through. In Burstow and Weitz's collection of survivor testimonials from the late 1980s, they argue that spoken and written psychiatrized experiences are an important avenue through which oppressions can be highlighted, a theoretical thread commonly ignored within mainstream scientific literature. Their anthology, according to Burstow and Wietz, "is a creative and liberating response to the ‘treatments' which robbed many of us of our creativity, individuality, and freedom" (1988, p. 31). Allowing a space for survivors to speak demonstrates that many, as has been illustrated in Burstow and Shimrat's work, feel the many de-humanizing aspects of the psychiatric system, how drugs are often permanently brain-damaging, and how psychiatry is largely "obsessed with conformity and social control" (Burstow and Weitz, 1988, p. 30).


Peter Breggin and David Cohen's work is often cited in survivor literature, especially since the two are committed to support survivor's paths to self-determination. The affinity between medical doctors, activist academics, and survivors themselves aids in promoting empathetic support – rather than simply handing out medication. Not all psychiatrists hand out medication without empathy, but Breggin and Cohen argue that throughout the 1990s, also known as the ‘decade of the brain,' the diagnosis and treatment of mental illness has moved further away from patient perspectives with caring paths to recovery. Often, as Breggin notes, those suffering from mental illnesses are ‘swept away' by the biological model of psychiatry, where many survivors end up with permanent brain damage from drugs and shock treatment (1991). Langian in many ways, his analysis begins with listening to how women and men struggle with the stress of illness and pain of an unstable, misunderstood identity. His approach, conversely, opposes biological psychiatry's position that often says, "you can't talk to disease" (Breggin, 1994, p. 23). The communication and hearing of stories by doctors from survivors makes "no sense to doctors who want to control symptoms, such as hallucinations and delusions, with drugs, ECT, and incarceration" (Breggin, 1994, p. 23).


The idea that extreme instances of ‘irrationality' (emotion) are due to diseases in the brain, Breggin continues, is inseparable from the profession of psychiatry. If schizophrenia was not a disease, psychiatry would have little justification for its treatments: "the search for biological and genetic origins keeps many people employed and are well funded…the notion that patients have sick brains justifies psychiatry's unique power to treat patients against their will" (1991, p. 23). Not only does psychiatry maintain itself by searching for biological origins to abnormal symptoms of behavior, but also the organic approach to mental illness automatically excludes voice. How can we, as Breggin asks, listen to a diseased brain? How could a diseased brain ever know its own world more than medical experts, many of whom have financial ties to the pharmaceutical industry?


Cohen and Breggin both suggest that if people who express ‘seemingly irrational ideas' are understood mechanistically, as they are in biological psychiatry, then these people are necessarily broken, disordered, and defective (Breggin, 1994; Cohen, 1988). Conversely, if a survivor approach replaced a mechanistic approach, recovery would be possible through opening up emotional dialogue for an understanding of those who seem mad, crazy, or dangerous: "if we are human beings rather than devices, then our most severe emotional and spiritual crises originate within ourselves, our families, and our society" (Breggin, 1994, p. 25). In a similar vein to Bonnie Burstow's work on testimony, Breggin acknowledges that self-determination happens through the expression of passionate emotion, which avoids being thrust back into the diagnosis as another symptom of a pathological illness.


Conclusion


Many scientists continue to reject the notion that symptoms of mental illness can be explained solely by biological or genetic origins, especially when the breadth of such origins are still ambiguous to scientists. For instance, classifying mental illness in the 1940s, as Jack Pressman (1998) highlighted, did not endorse a specific label supported by a diagnostic model, but the psychological behavioral and emotional features of their individual patients. In other words, mental illness was ‘diagnosed' by signs and symptoms of an illness – often irrational and emotional – while presupposing the origins of psychosis in the diseased brain. Even though medication and/or electroshock therapies treated the illness, the procedure and the diagnostic tools to define illness always did and continue to depend upon the physical behaviors of patients (Duffin, 1999; Breggin, 1994).


In the words of R.D. Laing, the diagnosis of individuals as ‘mentally ill' is a "social prescription that rationalizes a set of social actions whereby the labeled person is annexed by others, who are legally sanctioned, medically empowered, and morally obliged, to become responsible for the person labeled" (Laing and Esterson, 1964, p. 18). In other words, while ‘abnormal' social behaviors appear to be a result of an ‘illness,' such behaviors may be more closely related to larger political, economic, and social factors that are internalized by the individual diagnosed as ‘ill.' In short, more important questions emerge when critiquing biological models of mental illness through testimonials: how can we take what we call ‘mental illness' out of its clinical context, which has contributed to the degradation of individuals? Can the clinical biology that attempts to derive concepts from the multiplicities of human beings be more harmful or dangerous than the ‘illness' applied to those said to be suffering?


According to R.D. Laing, in the clinical world, individuals diagnosed as mentally ‘ill' are not only subsequently treated as sick in need of a cure, but are also invalidated as human beings by the medical world and beyond (Laing and Esterson, 1964). He argues that it is important to consider the ways in which the medical world necessarily places a (hypothetical) disease of unknown etiology and undiscovered pathology onto individuals as a result of ‘signs' and ‘symptoms' of ‘abnormal' behavior. Gilles Deleuze eloquently sums this up: "…the very nature of the symptoms makes them difficult to systematize, to combine in a coherent and readily localizable entity. They come apart at the seams. Schizophrenia is a syndrome in disarray at every point, ceaselessly retreating from itself" (2006, p. 22). Laing and Esterson, in a similar vein, argue that the problem with psychiatry, biological and psychoanalytical, is found in the idea that patients, ill or otherwise, are in need of a ‘cure.' According to David Cooper (1967), this means working towards debunking the unfortunate social/political/economic/medical myth that the ‘abnormal' brain is automatically ‘diseased.'


Since the 1960s, the psychiatric survivor movement has been through multiple transformations and struggles, and has ranged in critiques of both the biological and psychoanalytical models of psychiatry (Laing, 1961; Cooper, 1967; Deleuze and Guattari, 1987; Deleuze, 2006). [12] While it is beyond the current scope of the paper to discuss the climate of ‘the movement,' [13] suffice it to say here that in Canada, at the very least, many continue to view psychiatry as problematic and are committed to combating its problems. While the mental health system in Canada helps many, testimonial responses to the practices of psychiatry highlight the need to build more affective and loving communities, to support the telling and publishing of personal stories (see Burstow and Weitz, 1988; Shimrat, 1997), and to lobby for survivors' rights (Breggin, 1994; Cohen, 1988; Burstow, 2004). The significance of ‘the movement' and the (emotional) voices of the survivors, according to Burstow (2004), is the interconnection of values and political commitments.


It is important to recognize that the voices of survivors come from positions of oppression, often intersecting with racialized, gendered or class-based inequalities, among others. Politically committing to why emotional voices matters, by affinity, invites those from a position of privilege to hear and act. While the concept of affinity as an ethical approach to activism has been around for some time, Richard Day develops the concept in his new book Gramsci is Dead (2006). Affinity, as opposed to counter-hegemonic forms of politics (which are often, but not always, totalizing), can be defined as "non-universalizing, non-hierarchical, non-coercive relationships based [on] mutual aid and shared ethical commitments" (Day, 2006, p. 9). Bonnie Burstow and Don Weitz, both anti-poverty and anti-psychiatry activists in the Toronto area, can generally be described as sharing such political and ethical commitments in their work.


While I cannot say for certain that all form of anti-poverty/anti-psychiatry activism can be defined as affinity-based, Burstow and Weitz's work, in particular, fits with Day's observation that progressive social change "responds to the need and aspirations of disparate identities without attempting to subsume them under a common project" (2006, p. 10). Hester Parr's work shares similar political undertones, especially in her discussion of interlocking issues in the UK related to poverty and mental health. Her analysis of ‘othered' voices within marginalized communities is important for a politics of affinity, especially in that it is based on a commitment to difference of disparate identities, not essential categories based on gender, race, ability or illness/health (Parr, 2000). The psychiatric survivor movement is seeking community, a space and place to speak from the positions of psychiatrized ‘others.' It is important for allies to recognize the need for life narratives "in which survivors reclaim and celebrate ways of being that psychiatry has reduced to diseased [like] symptoms" (Burstow, 2004). This includes challenging governmental policies that promote forms of psychiatric treatments such as electroshock and private, industry-based pharmaceutical treatment, forms that have historically denied – and continue to deny – the voices of psychiatrized ‘others' to speak and be heard.


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Notes

[1] I do not see the psychiatric survivor as a monolithic identity or category through which we can define every individual who has been involved, willfully or not, in the psychiatric system.  Instead, survivor is used here to denote how identity can be contextualized, or politicized, by survivors themselves; survivors share a critique of the psychiatric system and support each other’s pathway(s) to self-determination (Burstow, 2004).

[2] This is not to glorify the position of the survivor, as many have intense forms of suffering in a moral and political world that has largely ignored difference.  Instead, the survivor is understood to be an embodied position from which one speaks about surviving – my position is to help clear a space for them to speak; Gilles Deleuze and Michel Foucault refer to this process as a relay (Deleuze, 2004; Burstow, 2004).  This is not to other them by valorizing their identity as something it is not, but to understand that survivor knowledge comes from a unique and otherwise often oppressed position.  Recognizing the survivor position is not about sentimentalizing surviving as if suffering was something beautiful – a fairly common critique of Laing’s concept of ‘ontological insecurity’ in The Divided Self (1961) and other works.

[3] Page numbers correspond to the online document: http://www.phac-aspc.gc.ca/new_e.html

[4] For a more thorough analysis of the pathologization of emotion, especially in Freud’s work on hysteria, see Szasz (1961), p.75 – 97.

[5] For the purposes of this paper, I use the term ‘mentally ill’ very cautiously, as its historical meaning is rooted in disease-like and psychoanalytically encoded classifications.  Throughout this paper I do not agree with the label ‘mentally ill’ as it has been pathologized as diseased, but do accept that individuals experience, are challenged by, and shape the world in different ways that can be understood through science and the social studies of science.  In other words, being mentally ill, in neurobiologies, is often a deterministic label that only further subordinates experience – something this paper will challenge throughout.  I do accept, however, that mental illness can be understood by science (that we are, in part and always, biological) in a non-deterministic way, i.e. by challenging the equation that genetics or diseased brain = illness = being mentally ill.  One way of challenging this equation is by inserting embodied knowledge and emotion, which, I will argue, disrupts the equation itself.  Laing and Esterson take a similar position in Sanity, Madness, and the Family: “…although we ourselves do not accept the validity of the clinical terminology, it is necessary to establish the fact that the persons whose families we are describing are as ‘schizophrenic’ as anyone is…thus we have begun each account by a description, couched in clinical terms, of the experience and behavior of the person to whom ‘schizophrenia’ is attached” (1964, p. 19)

[6] For a good example of the (neo-liberal) individualization of mental health, see: Quality of Life Measurement Among Persons With Chronic Mental Illness: A Critique of Measures and Methods (Atkinson and Zibin, 1996).  This Health Canada document highlights, among other things, scales for the measurement of social and individual ‘emotional functioning’ whereby emotions are often reduced to quantifiable data.

[7]  In a similar political vein, groundless solidarity expands the domain of action by actively denying the possibility of a stable, pre-social, unchanging subject. As Richard Day observes, “the impossibility of a purely universal identity does not relieve us from the necessity of attempting to be in solidarity with others -- note that I say solidarity, not identity.  Solidarity occurs across identifications” (Day, 2006, p. 18).  Groundless solidarity, therefore, works when we acknowledge the multiplicity of struggles (and identities) which may not be directly tied to our own, but which we choose to support anyways.  For feminists, this may entail building links with anti-psychiatry movements going beyond specific feminist struggles towards anti-oppression in general.

[8]  This case study is especially interesting as ‘homosexuality’ was characterized as a mental illness by psychiatry and the Diagnostic and Statistical Manual (DSM-II – III) until the early 1970s.  If Valentine had written this paper thirty years ago, we would be reading her account as one by a psychiatric survivor.  Although ‘homosexuality’ is no longer medically characterized as a disorder, it still carries the social stigma of something other than the norm, as shown by Valentine’s harassment within an academic community.  For further reading about the medical diagnosis of ‘homosexuality,’ see Kirk and Kutchins (1992).

[9] Also relevant to the paper is the Foucauldian concept of ‘bio-power.’ Foucault sought to address the disciplinary parameters characterized in discourses and practices of ‘well-being’ in the biological sciences (Foucault, 1976/1990; see also Hacking, 1991,1998; Haraway, 2004).  Bio-power, broadly defined, involves the “will to categorize, compartmentalize and define life; to treat the human as species, to fragment and create within the biological” (Foucault, 1976/1990,  p. 147).  According to Foucault, bio-power is the increasing ordering of subjectivities under the guise of improving the welfare of the individual and the population.  To the genealogist, therefore, this order reveals itself to be a strategy – albeit a strategy with no one directing it – and whose end is the increase of power and order itself (Dreyfus and Rabinow, 1982; Foucault, 1976/1990; Foucault, 1997/2003; May, 1993).  Michael Hardt and Antoni Negri, who have built upon Foucault’s concept of bio-power in their book Empire, suggest that in contemporary societies “mechanisms of command become ever more ‘democratic,’ ever more immanent to the social field, distributed throughout the brains of the bodies of the citizens…[bio] power is now exercised through the machines that directly organize the brains and bodies toward a state of autonomous alienation from the sense of life and the desire for creativity” (Hardt and Negri, 2000, p. 23).

[10] A good example of this in practice is the Ontario Recovers Campaign (ORC), organized out of Street Health in downtown Toronto.  Recovery at the ORC is not about promoting a cure to a diseased brain.  It is about a conscious process with practical steps individuals take to speaking through recovery, forms of which will vary from survivor to survivor.  It also relies on essential material support, including adequate income, housing, and resources to be informed about treatment options, which would be an entire paper in and of itself.

[11]  The concept of recovery is important for studies in mental health, especially in that recovery is not synonymous with ‘being cured of an illness (see Davidson, 2003).  As illness tends to perpetuate the biological model and the ‘broken brain,’ recovery, conversely, is commonly defined experientially by survivors themselves.

[12] David Cooper similarly argues that “Psychoanalytic discourse reduces the normal verbal state of expression with all its disformities [sic] (including academic discourse in all the scientific disciplines that begin to become truly speculative, wondering about and doubting themselves) to the expression of earlier states of expressive being.  Mad discourse skirts around, reaches above all this to regions where it finds nothing – but an important and specific nothing that is creative precisely in the measure that it is not destroyed by the normalizing techniques of the society” (Cooper, 1978, p.21).

[13] I use scare quotes here to highlight that the psychiatric survivor social movement varies across regions of the world.  In spite of this variation, however, the movement does share international common goals of addressing forms of inequality within diagnosis and treatment of mental illness.  For more see Crossley (1998).


Institutional Affiliation and Correspondence: Christopher Canning is a PhD Candidate in the Department of Sociology, Queen's University, Kingston, Ontario, Canada. Email: 1cgc@qlink.queensu.ca.


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