Anti-psychiatry: the triumph of irrationality and human rights movement in psychiatry?

A new direction in the study of the nature of mental disorders, their causes, and identify the "norm". On the perception of mental illness in the classical psychiatry and change it to the anti-psychiatry movement under the influence of the philosophy of existentialism speaks Dr. Doping, describing the evolution of ideas about the difference between insanity and health.

From "Handbook of neuropsychiatry" to "Wrestling with insanity" Paul de Kruif

What is mental illness? Severe illness of neurosis? Is it true that any mental illness - a disease of the brain, and it follows that it is necessary to treat the brain? There was a time when all psychiatrists answered these questions positively. For the treatment of brain applied not only to tablets but even surgery! And it is not about some distant Middle Ages. "All mental illnesses are diseases of the brain," said the German psychiatrist Griesinger in the XIX century. But his words were the guiding light even in the 50-ies of XX century. Thus, the operation on the brain, the so-called lobotomy, is shown in the film "One Flew Over the Cuckoo's Nest" some exaggerated, but it is generally true. Neurology (diseases of the nervous system, including the brain) and psychiatry (mental illness) in the XIX century and early XX century were together. However, today our central magazine called: "Journal of Neurology and Psychiatry. SS Korsakov ".

Understanding mental illness and deviations vary significantly. By the beginning of XX century the most advanced psychiatrists and philosophers have understood one feature of psychiatry. This feature is still many deny, but it does not disappear. Psychiatry is twofold. Sometimes this is reflected in terms such as "big psychiatry" / "small psychiatry", "traditional psychiatry" / "psychotherapy", "physiological / psychological" Psychiatry and the like. Sometimes adherents of one of the areas of the right to deny the existence of the other. But, apparently, the most reasonable - is to accept this as a fact of duality. There are two aspects of mental illness: in terms of mind and brain of the patient point of view. And these two aspects are not reducible to each other. To improve cognitive function – buy Noopept, Picamilon, Piracetam and Cogitum.

The dispute between the areas of psychiatry, by the way, has a direct correlation to the philosophy, the dispute between the philosophy of mind. There, too, there are attempts to reduce all states of consciousness to the brain states, and another opinion, according to which to reduce consciousness to the brain is impossible.

How mental illness looks with these two different sides? From the point of view of physiology - already today, is not the time Griesinger - mental illness, such as schizophrenia, is the inadequate functioning of the dopamine system (a chemical in the brain, a neurotransmitter). A morbid anxiety panic attacks - in the serotonin system failure (also the mediator). It is worth noting that today physiologists generally dominated neurotransmitter view of the nature of mental illness.

From the point of view of psychology, or, in other words, understanding, mental illness - it is an experience, an emotion or idea, is that in the usual form is at all, but sometimes suddenly changed beyond recognition. Then schizophrenia appears as a so-called "ontological insecurity". And anxiety panic attacks - it's awful amplified analog of an ordinary human fear. To cope with stress – use Phenibut, Afobazol, Phenazepam.

Psychiatry History reminds swing: the first, the second approach is knocked forward. In the XIX century there were only two notable swings, but in the XX century, we can observe as much as 5 swing. At the beginning of the century continues (smear more in the second half of the XIX century) domination of the physiological approach. One of the most prominent psychiatrists of that time, Karl Jaspers (aka the famous philosopher) says in his autobiography that when he worked in a large and very modern at the time psychiatric Heidelberg Hospital, chief physician there was F. Nissl - expert in histology of nervous tissue that is, simply put, a brain researcher. It is understood that the brain to explore could then only on cadavers. Well, apparently, the hospital supplied him enough corpses to work. Now the fact - histologist headed psychiatric hospitals - already tells us a lot.

The activities of the Jaspers (and with it should be called Freud and Bleuler) contributed to the fact that the 30th years of XX century, the pendulum has swung the other way. So we can talk about understanding the mentally ill, that illness has its own meaning and its psychological causes.

However, in the 50s of XX century physiological approach took the biggest rematch. The reason is simple: there were chemical medicines, Cropped (stops) psychotic symptoms. Even before that, about the middle of the 40s, widespread shock therapy and lobotomy. In short, the physiological psychiatry has learned to treat mental illness. It would seem, what kind of "psychological understanding" reasons after that can we talk?

But until the moment when the pendulum ran in the opposite direction, it was not much.

In 1957 he published an interesting book by American writer Paul de Kruif "Fighting madness» ( «A Man against Insanity»). Its main advantage, of course, fun. She's really smart and understanding written by the author. According to the ideology of the book is a purely positivist (physiological) look at mental illness as abnormalities in brain biochemistry. It is still worth reading, so it is great to be written. However, we find in the text of de Kruif more than positivism than physiology. Talking about his character - a psychiatrist and researcher, the author emphasizes the importance of understanding the painful experiences. And all the time keeps saying how important it is to "love" of patients. This text is full of mercy and compassion - something totally positivistic. While pathos de Kruif, of course, is that the patient should be loved regardless of disease (and not, for example, to love him for his disease, because the disease of interest), such an attitude will certainly encourages a desire to understand the experience of patients.

From "Wrestling with insanity" to "Divided Self" Ronald Laing

Two of these works came out about the same time (1957 and 1960), but the ideological chasm separates them. Unlike de Kruif, Laing - psychiatrist. In his youth he worked as a doctor in the city of Glasgow city hospital in serious department, where patients were hopeless. Many of them had been lobotomized, but has not brought benefits. Laing has worked hard to improve the content of the patients on a more human attitude towards him, but it does not go beyond, in general, the same charity, which was characteristic of pathos de Kruif. But then he got an internship Donald Winnicott, a well-known child psychiatrist and psychoanalyst. It has armed it with a new approach to the psyche, which he, however, reworked according to their own experience and common sense. Winnicott - a pupil of the famous Melanie Klein, the author of the psychoanalytic theory of child development. This theory is very interesting, but very little corresponds to everyday common sense (this is typical for psychoanalysis). Moreover, it is little suited Laing in explaining the causes of severe schizophrenic disorders in adults.

However, the core of understanding Laing picked up yet, through Winnicott, in Klein, and by Klein and Freud himself. The main thing is that he understood - that in some sense schizophrenia is a degradation of the I to the infancy of disintegration, the splitting of autism (autism - this appeal I am not a reality but a fantasy). It turns out that a healthy person has to spend the effort to maintain the Self in an integrated state. The effort required and the treatment I'm back to reality. Healthy people do not notice it, simply because he has enough forces. This is just as the one who has not hurt the joints, does not notice how hard it is to actually move them. Only when they are ill, every movement is noticeable.

Thanks to its exceptional capacity for empathy, understanding that has been a characteristic feature of his personality (writes about this in his memoirs, such as Fritjof Capra), Laing penetrated deeply into the experiences of his patients. These were people, the psychological forces which were specially reduced. Laing gave it the name "ontological insecurity". This means that they both have an insecure existence. They require effort every action in reality that a healthy person does without thinking. View window, for example. Is it difficult to look out the window? But ontologically insecure person all can be permeated with fear and loathing. Big impression on Laing's famous French writer and philosopher Jean-Paul Sartre, who in "Nausea" novel artistic, and philosophical work "Being and Nothingness" theoretically described as the world presses in the ontologically insecure person. Sartre belongs to the famous phrase "Hell - is another." Laing watched with schizophrenia, also came to the conclusion that the other - this is the most severe for them the most, so to speak, of the pathogenic world. The schizophrenic goes to his autism, to escape the pressure further.

Thus, Laing realized that even the Jaspers believed essentially impossible: he understood the psychological state of patients with schizophrenia. His book "Divided Self" is written so clearly and psychologically certain that after reading it, even many healthy people would say, "I also felt something like that."

From "Divided Self" to "Politics experience"

In the early 60s there have been significant changes in the outlook of Laing.

Firstly, in a society ripe outrage lobotomy practice. Antipsychotics, which are in such an enthusiastic tone wrote P. de Kruif turned out to have the same side effects as the lobotomy (the person ceases to be an independent free subject), except that the transient. That is lobotomy cripple forever, and the action of neuroleptic passes if they cancel the reception (but in fact many have to make something of their life!). Psychiatric hospitals were mainly places of detention and shame, locked iron doors with bars on the windows and plastic with the included light at night.

And then it came, as they say, "Roaring Sixties". Then something was in the air. All were eager to upgrade. Even shy people were ready to protest. Even in totalitarian countries rushed winds updates. Recall our "Sixties"! Old habits, customs, fears and expectations have changed in all directions, and all were ready to change everything that is not laziness.

Against what were protesting students at the Sorbonne in Paris in 1968? I am afraid that with this move and we do not understand. For example, among their slogans was "All power to the imagination!" If you think about it, in general, how is it? Instead, what is, in reality, to teach what the university lecturer imagined? And the fact that there are real, no one is more interested in, or what? And the something you're protesting, is real? All this is difficult to lead to some type of logical consistency. But these students took to the barricades! And with them it was Jean-Paul Sartre, who was 63 years old at the time! Well the power of imagination, when you're 17 years old, but when you're sixty-three? So great if there was a need to change something in the culture and society. Something subtle, but very important.

And still - to me personally, for example - and it remains unclear if it is worth doing or not.

Against what specifically protesting psychiatrists, much clearer. Lobotomy and antipsychotics, attitude to patients as "no-human", which should definitely be cured, to become fully human. This view of the madness of silence is present even in a very clever text de Kruif. Mentally ill should recover, it should be normal! That's what so far has been the aim of the activities of doctors.

In fact, the patient became normal at the time, when aware of their disease, and "recover and become normal" case and its own purpose. Even if he were still Symptoms (well, for example, a patient is afraid to look out the window), but it tends to recover, then it is not madness. In general, a normal person in front of us, and his fear of the window now called not psychosis, and phobia (a phobia - a type of neurosis, the disease is much easier than psychosis). But if he does not want to be cured, if the window for him "really dangerous", he is insane. His diagnosis then - "schizophrenia".

And if there is a sense of madness? And if it turns out that patients understand what they do not understand healthy? If they do see the danger that nobody sees but them? In any case, if they are going through something healthy can not survive? Though maybe sometimes even I wanted to?

This is the subject, for example, Foucault's book "The history of madness in the classical age." As Foucault writes, madness never given "voice". Madness has always repressed. The patient is forced to - or cruel manner, or a soft way, or even begging, but still essentially forced - to be healthy, to start being like everyone else. And be like everyone else in this case means, first of all: to become obvious to others.

After Laing wrote "Divided Self", a book about how to understand people with schizophrenia, the problem - that the patient has become clear to others - no longer standing in front of him. Doors of insanity, which until then had been closed, opened. Sam Laing them even went and did the same many readers of his book.

It became apparent that these doors have a life, and how it should lead to "normal" - a separate issue. And it very much depends on what is meant by "normal".

By itself, the "life behind the doors of madness" (this is obvious from the book "Divided Self", and "Policy experiences") - is suffering and, of course, not the norm. Laing is sometimes misinterpreted as if he called the madness of the highest health View (wrote Rutkiewicz AM) or claimed that between madness and health there is no difference, they both - only the types of social relationships (some anti-psychiatry, for example, T. Szasz, really as they claimed, but Laing). In fact, Laing has no doubt that the psychosis - a serious illness. It only indicates that we misunderstand the health and the causes of disease must be sought, not where we are looking for them.

In what he sees the causes of disease? Again, one has to wonder how the "madness" should lead to a "normal"? Here is the famous quote from the book of R. Laing "Politics experience": "With the perfect vantage point on the ground you can follow the order of combat aircraft. One aircraft may be out of order. But the entire order can not move ahead. The plane, being "out of order", may be abnormal - the sick and the "crazy" from the standpoint of the order. But the order itself with the ideal observer's point of view may be sick or crazy. The plane is outside the order, it may also not move at the rate - more or less than the order. The criterion of "out of order" - a clinically positivist criteria.

The criterion of "not at the exchange rate" - the ontological. Fundamentally, it is important not to make the positivist error, suggesting that because the group is "in order", it means that it necessarily moves "Exchange". If the order itself is not moving at the rate that people really move "Exchange", to leave the order. "

Laing introduces the term "rate card" - a human existential orientation. All we need to sort out something important: how to relate to others? How to relate to the world? To work, love art? To God and to the delight? What are the projects of your life to build, or maybe not build any?

Modern culture or does not provide answers to these existential questions, or answers are absolutely unsatisfactory. Course Map in our culture is lost, so that "the whole procedure does not move on the course." As Laing writes elsewhere, ego should feel like a servant of the divine, not a traitor. Laing thought that when the order is without a map, and not moving at the rate, then the people in this manner, which have a special sensitivity (ie, ontological uncertainty) lose their orientation is particularly acute, especially in tragedy.

But is it possible to get them back in order, if the order is not moving at the rate? After all, they are sharper than others feel this is wrong. They should be returned in some entirely different way, and in some very different place. But how and where? Here ends the criticism, which all have strong anti-psychiatry, and begin positive proposals, which are not always able to realize in reality. Laing tried to organize anti-psychiatric commune, even sought there is a high cure rate, but due to various circumstances and communes were closed and patients are back in the disease state itself Laing, unfortunately, ended his life tragically and sadly.

From "Politicians experiences" to the "Journal of the Independent Psychiatric Association"

In the 80 years of psychiatry in the West, the pendulum swung in the direction of drug therapy for severe psychoses and neuroses for lighter - to many psychotherapeutic schools. But antipsychiatry lessons were not lost. In addition to the absolute prohibition of lobotomy, social work with patients who have been paying more attention to the problems of rehabilitation and the so-called inclusion (the active inclusion of people with disabilities in social life) it has been significantly improved.

At the same time psychiatry in our country had a very different story. After a brief liberation in the sixties (and we did not have anything like activities Laing) began trials of dissidents in which psychiatrists, unfortunately, played an unenviable role of political henchmen torturers. Over-diagnosis of schizophrenia still exists throughout the world, this could not cope any antipsychiatry, but in our country this overdiagnosis in the 70-80s of the last century reached terrifying proportions. The diagnosis of "sluggish schizophrenia" set is not only political dissidents. Moreover, it would be wrong to even think that it was prepared people for one reason or another "inconvenient" for society. He received almost all, who just for some reason come to the attention of doctors. Almost from the verdict "healthy" by psychiatrists leaving only those who came, in fact, precisely because of a diagnosis or to obtain an exemption from the army, or insanity in court.

Times antipsychiatry in Russia came together with the restructuring and the end of repressive psychiatry. So it is possible, unfortunately, to joke that the main role played antipsychiatry MS Gorbachev. However, psychiatrists and, of course, I found a job.

For Laing antipsychiatry activity began with the fact that he has done work on the understanding of experiences of patients with schizophrenia. In this he relied on Winnicott and Klein, but not only. For the very idea of understanding are the names of the great psychiatrists early 20th century: Jaspers, Bleuler, Binswanger. We play a role as existentialist philosophers: the same Jaspers, and even Heidegger and Sartre. In general, the direction of "understanding" in psychiatry was called existential-phenomenological. Sami these things - understanding of patients and anti-psychiatric trend (at least in the form of psychiatry reform towards greater humanization) are inextricably linked.

All of this, no one knew in our psychiatry. In the mid-80s it has not been transferred not only the basic philosophical writings of Heidegger and Sartre, but even purely mental work Jaspers and Bleuler. Our psychiatry has hitherto always been exclusively positivistic and physiological spirit. With positivism repressive linked in spirit as inextricably as understanding - antipsychiatry.

Thus, the anti-psychiatry activity in our country - they are united in the so-called Independent Psychiatric Association (President - prominent domestic psychiatrist-clinician YS Savenko) - focuses on two priorities. Firstly, it is, of course, human rights protection issues in connection with overdiagnosis. Secondly, it is the introduction to psychiatry phenomenological method. In this direction, they spend a great and very useful activity. For though by 2000 the basic works of Jaspers and Bleuler, and Laing had already been, of course, translated into Russian, not the fact that psychiatrists practicing their reading and that in medical schools teachers even mentioned about them.

In the "Journal of the Independent Psychiatric Association" heading "clinical reviews" regularly present. In 2006 and in 2009 came the collections composed of materials of this section:. "Clinical analysis in psychiatric practice" The whole book includes descriptions of patients, stories about them, questioning them, transcripts of discussions between doctors in each case, etc. Read it more interesting than a novel! As is clear from the fact that the output of such a book, a group of like-minded people can keep a valuable tradition, even against the prevailing academic trends.

Times of fierce debate between supporters of the anti-psychiatry and repression thing of the past: in general, we can say that even in the domestic psychiatry human rights movement triumphed. Although it was given with difficulty, not yet brought to an end, and no guarantee that the won will remain forever.

However, never leave in the past disputes between psychiatrists physiological and phenomenological methods. Therefore antipsychiatry as the most active defender of the phenomenological method will always be in demand by those who seek to understand the madness: to understand its psychological causes, its meaning and place in the culture - and not just get rid of it.