Anti-Psychiatry: Re-turning the field of Child and Youth Care
What remains is the tumultuous sea in which we must face, not health and illness but life itself . . . Our current problem is the same Cortez faced after he burnt his ships: we have no bridges left behind us to help us sail the seas again in safety. (Basalgia 1987 p.32)
Late last summer I had the opportunity to be on a panel at Manchester Metropolitan University as part of a conference that was centered on World Hearing Voices Day. This event was inspired by an international movement called the Hearing Voices network which is composed of mental health professionals, academic researchers, and people who hear voices. The movement is premised upon the idea that hearing voices is best understood not by psychiatrists, psychologists, or other mental health professionals but by the voice hearers themselves. As a result the Hearing Voices Network is made up of small groups of voice hearers around the world, who come together to,
share the experience of hearing voices . . . help and support each other . . . exchange information and learn from each other. They share the same problems and may have similar life situations. The purpose of hearing voices groups is to offer a safe haven where people feel accepted and comfortable. They also have an aim of offering an opportunity to for people to accept and ‘live with their voices’, in a way that gives some control and helps them to regain some power over their lives. http://www.hearing-voices.org
While there is much to say about this movement in its specific and courageous resistance to the dominant psychiatric discourse and the predations of the psycho-pharmacological machine, I want to focus instead on what implications this movement has for the field of child and youth care. To do this I want to situate the movement as a certain kind of return to an earlier moment in the history of social service. It is a moment that, in many respects opened the door for the development of the very field of child and youth care. Yet, up until very recently it was a revolution that failed and had largely been forgotten within the social service field as a whole. That forgotten revolution was called anti-psychiatry.
I first encountered anti-psychiatry in the community based mental health center where I held my first job in social services. Although I didn’t know it at the time I was entering a world that was already closing. When I presented myself as a volunteer with no training in psychology or counseling (only a B.A. in comparative literature and a personal history of managing madness) I didn’t know that the experience would alter the course of my life. I only wanted to do a bit of good in the world; offer some compassion to the suffering; perhaps suture up a few of my own psychic wounds. However, the space I entered was a wildly open space of unfettered social experimentation and revolutionary impetus.
Some of that was the time and the influence of the new and radical therapies of the 60’s and 70’s. After all, this was the moment in which the dominance of the medical model, the pre-imminence of the psychiatrist and the psycho-analyst would be overthrown and the mad would be returned to their communities. The community would break down the barriers of reason and recognize the mad as our own. We would all embrace our own madness and humanize our world through recognizing the insanity of capitalism, war, poverty, racism and injustices of all kinds.
It was an exciting time composed of multiple social and therapeutic experiments and it was largely finished within four years of my arrival. Nonetheless I was able escape being properly inducted into the traditional theories and practices of psychology and psychiatry until my master’s degree some years later. Instead, I was able to train directly with innovators in the newly emerging field of family therapy, brief strategic therapy, Ericksonian hypnosis and what was called community based mental health. Community mental health, at the time was poised at a cross roads, not unlike the juncture we find ourselves at in the field of child and youth care today.
The community mental health center where I found myself working was the end result of a long process of what was called deinstitutionalization. This process was begun by a psychiatrist in Italy named Franco Basaglia. As a young psychiatrist Basaglia entered the back wards of what was called the manicomio or lunatic asylum. What he found there when he arrived was a system of horrors not unlike those found in the concentration camps of the Nazi’s.
A journalist whose expose on hospitals provided cannon fodder for the reform movement in the United States wrote in 1948:
“As I passed through some of Byberry’s wards, I was reminded of the pictures of the Nazi concentration camps at Belsen and Buchenwald. I entered buildings swarming with naked humans herded like cattle and treated with less concern, pervaded by a fetid odor so heavy, so nauseating, that the stench seemed to have a physical existence of its own.” (Basaglia 1987 p. 305-306 n. 15)
For those of us whose history does not include the documentaries and exposes of the de-institutionalization movement of the 1960’s and 70’s its hard to imagine the visceral tragedy of such institutions for those now largely released into the community. It is important to note, however, that the field of child and youth care is built out of the same historical conditions. The drive to return young people to their communities and to release them from the brutal conditions of adult jails and mental institutions was premised on the pioneering work of Basaglia.
This work was the driving impetus behind finding alternatives to adult institutions for those young people who had committed status offenses such as leaving home without adult sanction. I first ran across this history when I took a job at a youth shelter in New Mexico called La Otra Puerta or The Other Door. It seemed an interesting name and when I first started working there I asked how the name had come about. I was told that the first location for the shelter was in the same building as the adult jail. Up until the establishment of the shelter young people who left home were arrested and placed in the adult jail. With the advent of the shelter they were afforded another option that could be accessed through the door directly next to the door to the adult jail; hence the name The Other Door.
In this respect among others, the field of child and youth care has much to be proud of. Many of us have worked very hard to de-institutionalize the struggles of young people and to assure their meaningful place in our communities. We have fought for legislation locally, nationally and internationally to assure young people of their rights and freedoms. In many instances we have succeeded and young people are now provided safe haven and assistance in shelters, foster homes, and through the efforts of street based workers throughout the world.
However, we should not imagine that the day of the institution has passed. Indeed, we might well argue that it has both been more broadly extended and intensively applied. On the one hand, we can point directly to the moves since the 1990’s to create “safety” for young people through increased rates of incarceration in treatment centers, residential facilities and detention centers. Certainly the move towards creating secure “shelters” for chronic runways with barbed wire perimeters, barred windows and locked doors is revitalization of the institution as a social force. This is a far cry from the early days when youth shelters were radically opposed to any form of disciplinary sanction. I can remember a highly respected public advocate and extremely effective lobbyist in Washington DC recounting the days when she ran a runaway shelter. She told the story of how whenever the police would come looking for a young person she would sneak him or her out the back door and out of the reach of the authorities. Perhaps we should ask how we managed to become those very authorities.
In this sense, I would argue that the back-ward has not disappeared nor been replaced with the kinder, gentler regimes of medications and juridical protection contrary to the popular mythologies of liberal democratic medicine. It has simply metastasized across the social to the homeless on the streets, the dispossessed of the nation states, the radical excluded of the barrios and favelas, the youth and children disowned by their communities, and the elders left out to die or be forgotten.
The revitalization of the asylum in all its new forms turns the social institutions designed to protect us from “terror”, create safe spaces for children and elders, or shelter us from the depredations of war and famine into spaces of purgatory in which we await; but not the entrance to heaven. Indeed, such social institutions as radically excluded spaces of waiting are counter-therapeutic in the sense that far from promoting a vibrant and productive network of creative bodies producing a sustainable world that supports all life; they instead produce absolute and total violence. If we doubt this, we need only turn to the recent sexual assaults of young men in the custody of the outsourced penal institution in Texas or the murders and abuse of children in foster homes across North America where the conditions reported mirror the same conditions Basaglia encountered in the back wards of the asylum itself. One might well say that nearly forty years after the ground breaking and revolutionary work of Basaglia and others we are again faced with the crisis of the asylum.
In many cases, however, it is now an asylum without walls or bars. We, as child and youth care providers can certainly point to many well run institutions and programs for young people that are clean, safe, organized and humane. However, one must be careful here. The question goes beyond the surface of a well run institution. What Basaglia and his colleagues sought was far more than this. They were not interested in the production what Foucault calls docile bodies, or those bodies produced to the benefit of the ruling elite through mediations, disciplinary practices and behavioral modification. Instead they sought the abolition of the system of domination embodied in the practices of the asylum. As Basaglia (1987) notes,
No possible alternative to the institution exists unless it is a constant and practical critique of every form of institution: from the mental hospital to the mental health system, from the center to the neighborhood. (p.41)
The field of child and youth care sits at the crossroads of opposing inclinations. On the one hand we have a long history of democratic advocacy and program design. On the other we have a drive towards increased disciplinarily and adoption of the profit making incentives of the new prison industry which replaces the factory in postmodern capitalism. We have, as a field adopted, in many instances a very real set of relations with young people in which we have struggled to recognize the realities of their oppression and engage with them on a level of parity and common humanity. Opposed to this we have entertained and deployed the worst kind of dehumanizing practices in which we can only see the young people we encounter as sets of problems to be solved, moral failures, inferior ethics, and diagnostic categories. On another register we have worked very hard to include young people on our boards, planning bodies, advocacy organizations and even as co-researchers and writers. We have highlighted their voice and made much ado about their inclusion as political actors in the field. Having done this, we now feel that we need to have a clear professional identity separate from them in which they have no real possibility of participating. We want the respect of the institutions and governmental structures that have such a dubious history in their oversight of the fields of psychiatry, social work, psychology, and foster care. We want rules, procedures, protections, higher wages, and a professional identity. One must ask, when requesting inclusion into the systems of domination and power, is there a compromise made in the ability to effectively advocate for those on the outside of just such systems? This crossroads, I would argue is situated between the original vision of anti-psychiatry or de-institutionalization precisely in the way that Basaglia outlines it above. There can be no alternative to the system of domination “unless it is a constant and practical critique of every form of institution.”
It seems to me that we have a choice to make here. When I first went to work at the mental health center, the staff was comprised of about 80% community volunteers. There were people from the community such as myself who just walked in off the street as well as Mennonite and Catholic Worker volunteers. The professional staff was minimal and mostly related to supervision, nursing and direct psychiatric practice. The direct care was provided by people from the community. This was Basaglia’s vision; to break down the barriers between the institution and the community. He was interested in democratizing the institution by opening it up to a flow between the inside and the outside. He promoted practices that broke down the walls, barriers, bars and identities that separated and alienated those contained within the institution. As Scheper-Hughes and Lovell (1987) point out.
The anti-institutional psychiatry inherited from Basaglia constantly creates situations for socialization — not in the sense of retraining ex-patients in basic skills of relating inoffensively to others and conforming to social institutions, but of bringing people, ex-patient and not, together, allowing them to interact and support one another and to face their problems together. (p. 48)
We must ask, how does this vision of a holistic community working together to reintegrate its members through an open flow between the community and the institution reconcile with the current drive in our field towards becoming more professional through licensing and credentialing? How does these inclinations towards producing a privileged status for us as adult workers bring us closer to the young people we serve? Is this even our goal any longer?
Basaglia’s vision was of an open democratic system of inclusion that challenged the bounded space of the asylum. He unlocked the back wards and then found that the patients were so imbedded within the institutions they no longer knew how to leave. So, he instituted large and open meetings that included the staff, psychiatrists, patients and community members. He promoted an open uncensored airing of grievances with equal voice for all in attendance without rules or procedures. Then he took the staff and the patients on a tour of the asylum and with sledge hammers and crow bars they jointly destroyed the symbols of oppression.
How many of us in child and youth care institutions are willing to hold uncensored, truly open meetings with young people in which they can say anything they like without repercussion or sanction? Would we be willing to destroy the artifacts of our power as staff; our special spaces, offices, nursing stations, medication rooms, spaces of restraint, locked doors and hidden records? How invested are we in our power and ownership of the institutions in which we work? Do we hear ourselves when we say that we must avoid the youth “taking over?” Must we maintain control and dominance? Are our programs open to spontaneous interactions with the community that surrounds them? Who owns our space; the staff, the youth, the community, the government, the funders, the corporations—who? To whom must we answer? What is our task and who defines it? Basaglia (1987) said that our job is,
To facilitate an understanding of how ideology manages to make the subordinate class accept measures that seem to meet its needs, but which in reality is destructive. Perhaps that is politically more effective for us than pretending to be workers, which we are not, or borrowing their motivations for struggle, when our profession often involves us as hidden accomplices. Rejecting one’s role and authority dialectically through a critique of science as ideology, or a tool for manipulating consent, involves knowledge of the direct relationship between the dominant group, the functionary (both the intellectual or the theoretician who produce the ideology and the technician who translates it into practice), and the dominant group’s use for then ideology. (p.149)
In other words, Basaglia is suggesting that our job is to understand how systems of dominance produce the conditions that bring young people to us in the first place. We need to understand the ways in which this reality is hidden from view and replaced with another reality in which the most powerful are the least responsible and the least powerful must be held accountable for every action and infraction no matter how small. He suggests that our unexamined role is not really that of workers, but as accomplices to the systems of power under which young people suffer. We need to reject the role of accomplice, according to Basaglia, and in doing so abandon our authority and join with young people in understanding and resisting those social discourses that de-humanize and pathologize children and youth. Further, we need to understand that these discourses cannot simply be replaced with new and more humane modes of discipline such as assets based approaches, solution focused therapies, cognitive restructuring, behavioral intervention, or creating cultural capital. These discourses are ideological constructs that continue to keep our focus on changing young people so they can accommodate smoothly into the regimes of power. By keeping our eyes on the behavior and practices of young people we become technicians on behalf of the ruling class. Basaglia calls out for us to abandon this position and work with young people to take on the political task of first understanding the social and economic forms that dominate and form our lives and relationships, as both youth and adults, and then to take action to bring about a new world. He states that,
If we are to transform reality we still have the problem of simultaneously transforming ourselves. The transformation of human beings is the most difficult one, for we are imbued with a culture that makes us deny even our own contradictions, by rationalizations and escapes into an ideology that exaggerates only one side of all contradictions (Basaglia 1987 p. 193)
This is the heart of the contradiction in our field. Do we have the courage to face ourselves? Can we, to paraphrase the old comic strip Pogo know that “we have met the enemy and he is us?”
The world can be a terrifying place in which we seek security, safety and shelter from the storm raging around us. For some of us the solution is more discipline, more rules, more security technology, and more restrictions on behavior. We turn to the most powerful forces in society and request permission to act on their behalf in containing and controlling the weakest and least powerful. In this we don’t recognize that the forces at the heart of the storm do not reside in the young people we encounter. Their behavior is a symptom not a cause of the malaise. Their acts of resistance and rebellion are sensible responses to the current conditions imposed upon them. As Basaglia also points out, the institutional force of the asylum can completely submerge the subjectivity of those within it.
For all of us living in the world of global capitalism there really is no outside. The logic of the system invades every nook and cranny of our lives. Basaglia says that when the institution becomes the rule of life and we become inseparable from it, then the only reasonable response is self destruction. It would be hard to argue that we don’t see that self destruction everywhere we look within our programs. As the recent tragedy at Virginia Tech points out there can be no safety because there is no security in the face of the will to self destruction.
The idea that we can be saved through greater disciplinary technologies, warning sirens, metal detectors, green zones, increased police presence, more prisons, more barbed wire, more bars, more authority, more laws and less freedom is useless in the face of someone whose goal is to die while killing the rest of us; someone whose hatred is not just for us but for themselves as well. Such a person is fearless and such people are being produced in quantity by the world in which we live. This is a bleak projection, but I believe that it is precisely through work such as ours that this can be turned around. R.D. Laing who was another anti-psychiatrist once said that
Someone has to overcome this fear, this flight from the pain of others that reminds us of our own unhappiness, our own limits and desperation. (Laing cited in Basaglia 1987 p. 199)
In the novel Dune Frank Herbert (2006) reminds us that “fear is the mind killer.” (p.19) When we operate out of fear and anxiety we make poor decisions. Nothing fuels fear like the sense that someone is radically alien to us. Nothing overcomes fear like the sense that we are all working together for a common purpose. We produce the radically alien other, as Laing suggest, out of “our own unhappiness, limits and desperation.” If we are to free ourselves from the madness of the global capitalist asylum then we need to overcome our complicity in its construction. We have to face squarely the contradictions of our roles and the way in which our cynicism is built out of our own sense of limits. We need to open up those limits and acknowledge the desperation they contain and manage. It is precisely through such desperation that the impetus to change the world arises. However, in doing this we need to realize as Basaglia did that it must all be done collectively and with common purpose. We need to open the gates of the asylum and then discover that we don’t know how to leave. It is at this moment that we will need to recognize that there is no alien other that needs to be contained or controlled; that the alien other is us and only we can bring about our own liberation. If we want the violence to stop then we have to free each other from our identification with a system premised on blood sacrifice and the consumption of all human life in the service of an abstraction called profit.
Basaglia, F. (1987). Psychiatry Inside Out: Selected Writings of Franco Basaglia. N. Scheper-Hughes and A.M. Lovell, Eds. (Trans. A.M. Lovell and T. Shtob). New York: Columbia University Press.
Herbert, F. (2006). Dune. New York: Hodder & Stoughton.