Madness – A New Approach

The Occupy Movement’s achievements, in drawing attention to matters that are fundamentally important for every single one of us, have been remarkable. In this article I will outline what critical psychiatry is, then offer a personal view of the resonance between critical psychiatry and Occupy. Finally I will contrast what I and others have called a global understanding of “madness,” based in a Western, technological world view, with local understandings of psychological difference based in a rainbow of communities.

In January 1999 a group of over twenty consultant psychiatrists working in the NHS met in Bradford because of deep concerns about the direction in which psychiatry was heading. These concerns related to the Labour government’s proposals to increase powers of coercion in mental health practice, the growing influence of the pharmaceutical industry on the profession, and the rise of biomedical explanations for and technological responses to madness. Since then the Critical Psychiatry Network has campaigned actively in alliance with radical survivor and service user groups.

In my own view, one not necessarily shared by all who identify themselves as critical psychiatrists, many affinities can be found between Occupy and critical psychiatry. Occupy London’s Initial Statement itself is something I and many of my colleagues would certainly endorse. The demand for authentic global equality is particularly significant, along with a call to prioritise the world’s resources for caring for people and the planet over the wealthy, corporate greed and the military. It calls for a sustainable economic system that benefits present and future generations, and calls for an end to government actions that oppress people globally.

The statement also highlights the importance of diversity and difference which I would relate to the way we make sense of ourselves as human beings, the myriad ways in which we understand our suffering, distress and madness, in the face of the globalisation of Western concepts of mental illness and diagnoses.

Why? Who stands to gain from the globally homogenized approach to treating mental distress? Second only to the arms industry in the USA, Britain and Europe, the transnational pharmaceutical industry is the most profitable sector of this flawed and unjust economic system.  Despite the economic uncertainties of the last decade, the pharmaceutical industry maintained its position in the Fortune 500 list of most profitable companies. On average, company profits fell 53% in 2001, but the profits of the top ten US pharmaceutical companies rose by 33%, to $37.2 billion. They were the most profitable sector in the US, reporting a profit of 18.5 cents for every dollar of sales. The financial strength of the industry reflects a 30-year trend. The so-called “Decade of the Brain,” declared by George Bush Senior in 1990, saw a 50% increase in drug company median profit as a percentage of revenue. In 2006, global spending on prescription drugs topped $643 billion, even though growth slowed in Europe and North America. The United States accounts for almost half of the global pharmaceutical market, with $289 billion in annual sales followed by the EU and Japan. Emerging markets such as China, Russia, South Korea and Mexico outpaced that market, growing a huge 81 percent. US pharmaceutical industry profit growth was maintained as other industries saw little growth. According to Time magazine the pharmaceutical industry is – and has been for years – the most profitable of all businesses in the U.S.

It follows that the industry has immense influence on the medical profession as Joanna Moncrieff’s excellent paper Is Psychiatry For Sale? outlined. But there are other organisations who benefit from the globalization of Western concepts of madness. My colleague Suman Fernando points out that international organisations have great influence in shaping non-Western countries’ interpretations of and responses to their populations’ mental health needs. He draws attention to the ‘Grand Challenges in Global Mental Health’ programme, coordinated by the US National Institute of Mental Health in low and middle-income countries. Service user groups and community organisations have had little, if any, say in its development. The programme assumes that categories of mental illness like schizophrenia and depression as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual are universals, and that they arise from ‘molecular and cellular’ disturbances in the brain. But it pays scant attention to the interests and concerns of the communities for whom such Western concepts are alien.  Non-Western cultures envision quite different responses to madness and distress, based in local, cultural and spiritual support systems. Only the pharmaceutical industry benefits from the globalization of biomedical psychiatry, a process that risks irreparable harm to diverse indigenous beliefs and healing systems across the globe.

Global knowledge purports to be universal, relevant to all cultures at all times. Its epistemology is tightly defined, and protected by terminology, jargon and notions of expertise. Its interpretive systems include science and biomedicine, psychiatry and cognitive psychology, as well as sociology. It espouses the values and beliefs of global capitalism, demonstrated by the pharmaceutical industry’s vigorous marketing campaigns. It seeks to exploit human relationships and the environment for its own purposes, serving corporate interests such as those of the pharmaceutical industry, the World Health Organisation, governments and professional elites like the World Psychiatric Association. It sees the outcome of madness in terms of cure and risk, leading to stigma and social exclusion. It seeks these outcomes through unsustainable, top-down systems of ‘care’ that are little more than medication delivery systems.

In contrast, the epistemology of local systems is heterogeneous, its values are participatory and democratic, based in social justice, diversity, and sustainable human relationships. Its interpretive systems are truly diverse, encompassing all forms of spirituality, lay belief systems, as well as the social and political struggles shared by oppressed and excluded groups. It functions economically on the basis of social bartering, black or grey economies based on local trust and inter-connectivity between households and families. Poverty and the need to subsist mediate people’s day-to-day priorities, and this serves the interests of ordinary people, those who experience madness, their families, activist groupings, and communities. It sees madness as part of the human condition, a journey towards enlightenment, or as a Shamanic phenomenon. It too is concerned with crisis, but it negotiates risk within the community. It sees the ultimate outcome of madness in terms of social inclusion and recovery, delivered through sustainable local support systems.

This isn’t a romanticized view. Local systems of knowledge and support are already well-established. There is the work of survivor groups like the Hearing Voices Network, Mad Pride, and community development projects such as Sharing Voices Bradford. In Britain there is a strong, radical tradition of community development originating with the Quakers, Robert Owen and so-called ‘utopian’ socialism, and the cooperative movement. Further afield, its ideals resonate strongly with Gandhi’s Ashram, Julius Nyerere’s work on Ujamaa (familyhood) in Tanzania, and Paolo Freire’s critical pedagogy in Brazil. Community development and related forms of community action and consciousness-raising can play a central role in drawing together marginalized and oppressed groups and enabling them to challenge and respond to the sources of their oppression.

It was an inspiration meeting with people and discussing these issues in a recent talk I gave at Tent City University. I hope that the interrelated debates surrounding both Occupy and the desperately needed change to our approach to madness will continue to grow together.

Philip Thomas is Co-Chair of the Critical Psychiatry Network