💾 Archived View for library.inu.red › file › itay-kander-mh-anarchism.gmi captured on 2023-01-29 at 10:54:36. Gemini links have been rewritten to link to archived content
➡️ Next capture (2024-07-09)
-=-=-=-=-=-=-
Title: High Time for Anarchism in Mental Health Author: Itay Kander Date: 14/11/19 Language: en Topics: Mental Health, Mental health incarceration, Israel/Palestine, Colin Ward, welfare state, Ursula K. Le Guin, Ursula Le Guin, Soteria, Laing, Psychology Source: https://www.madinamerica.com/2019/11/high-time-for-anarchism-in-mental-health/ Notes: This article has been translated from Hebrew and edited voluntarily by a small group of people (most of them are Hebrew-speaking anarchists: Roni Slonim, Y.R., Uzi Esh and Veronica Song). I thank them for their assistance. The Hebrew version can be found here: http://bit.ly/mh-ana-heb] .
The mental health system, despite all its complexity, can be described
as a drainage hole for human suffering. Mostly, the pain that flows into
it seeps into the groundwater, but occasionally it will reverse course
and erupt into “normal” life as if from a geyser.
Reducing a wide collection of psycho-social phenomena into one generic
mold of “human suffering” without committing a grave injustice to the
diversity of voices within the “patient” community, voices that yearn to
be differentiated and heard, is extremely difficult. Nevertheless, my
experience has shown that a certain pattern or structure does underlie
most interactions in the mental health system — often, the pain
encountered in its bounds combines a type of Hurt, the conviction that
something wrong and unjust has happened to me, with some kind of
Silence, indicated by a paucity of language in the interpersonal space
and in some cases, the actual inability to put one’s experience into
words. These two features — Hurt and Silence — usually merge and become
inseparable. Thus, in the interaction with the “consumer,” the mental
health “professional” can either reinforce the foundation of Hurt and
sentence the “consumer” to continued silence or, alternatively, work
toward the disentangling of these two elements.
Anarchism refers to a broad political spectrum defined by the aspiration
for Equality and Freedom without elevating one over the other — in
anarchist thought, these two ideals are mostly viewed as two sides to
the same coin. Anarchism is also associated with dismantling unnecessary
hierarchies that have a negative impact on the social fabric.
In this short essay, I would like to examine how anarchist thought can
contribute to a foundation of equality and freedom of choice in the
delivery of mental health services for those in need.
Perhaps a decent beginning for our journey will be the Israeli present.
One of the tools that the anarchist has in her toolbox is almost passive
in its nature: Simply observing closely the myriad ways in which
libertarian ideology is manifested in the actuality of life, whether
this manifestation is a result of a unified intent or not (a completely
different tool, which I intend to use in just a few paragraphs down
below, is the tool of Imagination).
Today in Israel there exist seven “Stabilizing Homes.” These are
institutes, houses really, where one can go through a so-called acute
mental breakdown/breakthrough of the kind which will, in most cases and
without one of these houses in sight, be handled in a psychiatric
hospital. In contrast to traditional hospitals, there is barely any
coercion of any kind in these homes — and most importantly, none of the
brutal, physical kind. Because of that, the resident (a word given to
the person in the Stabilizing Home instead of “Mental Patient”) can also
leave the stabilizing home if he chooses to. Also, because admitting
oneself to stabilizing homes is done on a voluntary basis, and is
sometimes also free of charge — if health insurance covers it — it has
allowed non-violent practices to develop (this has been discovered and
discussed in detail by Social Worker Sivan Bar-on in her ground-breaking
research on Stabilizing Homes).
These non-violent practices create linguistic bridges that connect
supposedly far-removed worlds (e.g. the world of “psychotic” cognitive
states and the worlds of other, more socially-accepted cognitive
states). Stabilizing Homes have gained great success, both in the past —
in
, which is the prototype of the Stabilizing Homes — and in recent years,
with the number of Stabilizing Homes in Israel growing from one house in
2017 to
.
Can these Stabilizing Homes be understood as anarchist, or
semi-anarchist, endeavors? Perhaps if we asked
, the answer would be yes. Ward (1924–2010) is a well-known British
anarchist who has written numerous eye-opening articles and books about
welfare, health, education and housing policies, as seen through
modern-day socialist-libertarian lenses. Ward’s general stance on public
policy is that when facing a social problem, there are really two ways
to go: Either we choose the authoritarian route, in which people are
told what to do, or the libertarian way, in which people are allowed to
freely create their own communal solutions.
One of Ward’s most excellent examples for this principle is “The Free
playground”: A specially allocated space in the midst of the urban
jungle in which kids, with only a minimal amount of supervision, are
given basic tools and are allowed to play with them in a plethora of
ways. Ward presents research that shows that a libertarian environment
like this, very much unlike the more structured experience of the common
playground, sparks creativity in kids, builds important life skills,
fosters cooperation instead of competitive and violent behavior, and has
many other positive effects on children.
Now we can return to the question which we have only briefly discussed
before and inspect it thoroughly. The Stabilizing Homes have a manager,
they have professional and non-professional staff and obviously, there
are “residents,” who are informally — patients. At first glance, these
properties do not constitute a libertarian institute and the whole thing
seems incomparable to Ward’s free playground. But I believe that on an
even closer inspection, this is a relatively egalitarian, free and even
anarchist project. We can better think of these houses as a dot placed
on a line, one which starts with coercive and violent treatment inside a
closed psychiatric ward, and ends somewhere far, far away in our
imagination.
It is worth mentioning, in this context, a treatment method called
(Disclosure: together with social worker Sivan Bar On, I am organizing
about this approach). The Open Dialogue approach attributes great
importance to undoing the hierarchies existing between the Treating
System and the Treated System, for lack of better terms. In a typical
“Open Dialogue” meeting, all sit together for discourse in a circle, and
ideas and suggestions brought up by any participant (even those of a
qualified psychiatrist) are open to discussion and examination so that
others can give their opinion. Despite the fear and contempt that these
treatment models of Stabilizing Homes and Open Dialogue sometimes spark
among experienced mental health practitioners, it’s these models that
symbolize for me a ray of light within the mainly dark world of
psychiatry.
Surprisingly perhaps, research upon research shows that the
anti-authoritarian elements these methods have introduced to mental
health treatment actually promote a stronger, fuller recovery in
patients; and that they allow the patient’s voice to be heard far more
than ever before, enabling patients to verbalize their personal
suffering in an environment that listens to them. In other words, these
institutional treatment solutions also confirm Colin Ward’s life-long
argument — that the libertarian solution is not only the most moral then
the authoritarian solution, but it is also the most efficient one of the
two.
As a playful exercise for practicing our imagination and as a method for
building a good theoretical foundation to contemporary mental health
services, I would like to propose a discussion on the following
question: What would a completely anarchist treatment look like?
First of all, one option is that it won’t be a “treatment” at all.
Treatment in itself is a power structure, and as such can rot the very
roots of mutuality (similar criticism has already been proposed decades
ago by the thinkers of the post-modern school of psychology and notably
also in Jeffrey Moussaieff Masson’s Against Therapy). As an alternative
to the power structure dynamic of the patient-therapist relationship, a
structure that is reproduced in almost all forms of therapy, I propose
the idea of mutual alliance: an agreement, which is not legally binding,
serving as a framework for mutual psychological aid inside a certain
group of people. An alliance like this can be established in any place
where it is needed, with no preconditions except one: that all its
participants are freely willing to partake in a community formally
intent on mutual guarantee and solidarity. In our society, where
individualistic fragmentation generates loneliness and depression, a
mutual alliance such as this might be just the right solution for us.
Such an agreement could also strengthen communities whose members are
already under attack from “normality” and so must act in mutual
solidarity.
The obvious downside of a free alliance of this sort is that it doesn’t
necessarily have a certain person or group of people whose official role
is to accumulate information about psychological healing. Is this just a
negative quality? Could it also be a positive one? For me personally, it
is quite hard to decide what is preferable. Perhaps in this way, the
decentralized therapeutic knowledge will be accumulated and then
sustained collectively. Valuable information will not then concentrate
in the sole mind of a single person, a single lineage or a single
tradition, and it will be less prone to abuse.
But, I think, there is another vision which we can hold in our
imagination: one in which different therapeutic communities, like the
aforementioned Stabilizing Homes, will cancel the hierarchical
relationship between patient and therapist, but will conserve a great
deal of the knowledge they’ve acquired. A movement towards cancellation
of inner hierarchies will be a sort of return to the roots of the
Stabilizing Homes — most importantly, to the
Kingsley Hall experiment of R.D. Laing
and the Philadelphia Association. Different therapeutic communities
could then work in different ways — e.i. some could be mobile and while
others could remain immobile. Really, one can think of it as another
piece, a therapeutic one, of the cooperativist vision.
How far can we proceed in imagining an anarchist future in Mental
Health? When do we hit a wall?
Ursula Le Guinn (1929–2018) was one of the most influential
science-fiction writers of our times, and in one of her books, The
Dispossessed, she tells the story of a planet populated solely by
anarchists. It is an anarchist planet — Anarres is its name. In Anarres
there is no work and no government, no laws, no marriage and seemingly,
no psychiatric hospitals. In Anarres we witness the growth of our hero,
the brilliant physicist Shevek. Shevek comes in close contact with many
interesting characters in the book and one of his closest friends is the
playwright and satirist Tirin, who, as we learn towards the book’s
ending (I’m terribly sorry for the spoiler, but this regards a very
minor plotline!), has exiled himself in his mid-thirties to a remote
location. There, for his own good — or at least so we are told — he is
given psychoactive substances.
Ursula Le Guinn does a very good job describing how, in her opinion,
some human institutes will continue to exist even in a society that
doesn’t make use of hierarchic authority. In her anarchist utopia,
society still continues to spontaneously generate “madness” and “mad”
people. Le Guinn raises the idea that Mental health institutes can
solidify the meaning of “madness”, but that normative oppression (“The
Courage to be Normal,” as the slogan of a famous Israeli homophobic
campaign went) is an inherent part of being human. This is the pessimism
presented in The Dispossessed: Even when there are no actual physical
closed wards, human beings nonetheless continue to create invisible
wards with invisible bars.
By and large, the mental health system is a highly hierarchical one and
it uses authoritative measures generously. Forced institutionalization
and coercive “medical treatment” are located on the far end of a long
spectrum, and they are the most extreme use of a multi-faced power,
brought upon those who come to seek help from the system.
In these days, with the deaths of Oren Shalom, who died due to criminal
neglect in Abarbanel Psychiatric Hospital, and Israel Biadaga, who was
shot by a sanist and racist cop; in these days, when the Israeli public
is reconsidering the legitimacy of mechanically constraining patients in
psychiatric wards — Anarchism has much to offer the debate. Anarchism
can present a clear voice saying: Liberty is not an obstacle for quality
treatment, it is rather the very basis of it. And even if we do not yet
know the final limits of this freedom, both in terms of our capacities
as a society and in terms of the maximum good we can grant the
“patient,” the libertarian direction seems rather promising, and at any
point along the way we could stop and reconsider our compounded benefits
in comparison to our aggregated losses. Quite simply, we could
experiment in different types of reciprocal responsibility and emotional
assistance, and do so promptly, with no further delay, in our daily
lives.