us, beginning in 1939 through 1951, over 50,000 lobotomy operations were performed in mental hospitals, a procedure ultimately seen as inhumane. holocaust historians argued that the medicalization of social programs and systematic euthanasia of people in german mental institutions in the 1930s provided the institutional, procedural, and doctrinal origins of the mass murder of the 1940s. the nazi programs were called action t4 and action 14f13. the nuremberg trials convicted a number of psychiatrists who held key positions in nazi regimes. as one swiss psychiatrist stated: "a not so easy question to be answered is whether it should be allowed to destroy lives objectively 'unworthy of living' without the expressed request of its bearers. (...) even in incurable mentally ill ones suffering seriously from hallucinations and melancholic depressions and not being able to act, to a medical colleague i would ascript the right and in serious cases the duty to shorten — often for many years — the suffering" (bleuler, eugen, 1936: "die naturwissenschaftliche grundlage der ethik". schweizer archiv neurologie und psychiatrie, band 38, nr.2, s. 206). 1940s and 1950s the post-world war ii decades saw an enormous growth in psychiatry; many americans were persuaded that psychiatry and psychology, particularly psychoanalysis, were a key to happiness. meanwhile, most hospitalized mental patients received at best decent custodial care, and at worst, abuse and neglect. the psychoanalyst jacques lacan has been identified as an influence on later anti-psychiatry theory in the uk, and as being the first, in the 1940s and 50s, to professionally challenge psychoanalysis to reexamine its concepts and to appreciate psychosis as understandable. other influences on lacan included poetry and the surrealist movement, including the poetic power of patients' experiences. critics disputed this and questioned how his descriptions linked to his practical work. the names that came to be associated with the anti-psychiatry movement knew of lacan and acknowledged his contribution even if they did not entirely agree. the psychoanalyst erich fromm is also said to have articulated, in the 1950s, the secular humanistic concern of the coming anti-psychiatry movement. in the sane society (1955), fromm wrote "an unhealthy society is one which creates mutual hostility distrust, which transforms man into an instrument of use and exploitation for others, which deprives him of a sense of self, except inasmuch as he submits to others or becomes an automaton"..."yet many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. they hold that the problem of mental health in a society is only that of the number of 'unadjusted' individuals, and not of a possible unadjustment of the culture itself". graveyard attached to the church of st. thomas in west yorkshire, england, where thousands of internees from storthes hall hospital are buried in unmarked graves in the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, slowly came into use. although often accepted as an advance in some ways, there was opposition, partly due to serious adverse effects such as tardive dyskinesia, and partly due their "chemical straitjacket" effect and their alleged use to control and intimidate patients. patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. there was also increasing opposition to the large-scale use of psychiatric hospitals and institutions, and attempts were made to develop services in the community. the royal earlswood asylum for idiots was the first hospital for people with learning disabilities, led by lord palmerston, baron rothschild and lord ashley in the 1850s according to the encyclopedia of theory and practice in psychotherapy and counseling, "in the 1950s in the united states, a right-wing anti-mental health movement opposed psychiatry, seeing it as liberal, left-wing, subversive and anti-american or pro-communist. there were widespread fears that it threatened individual rights and undermined moral responsibility. an early skirmish was over the alaska mental health bill, where the right wing protestors were joined by the emerging scientology movement." the field of psychology sometimes came into opposition with psychiatry. behaviorists argued that mental disorder was a matter of learning not medicine; for example, hans eysenck argued that psychiatry "really has no role to play". the developing field of clinical psychology in particular came into close contact with psychiatry, often in opposition to its methods, theories and territories. 1960s coming to the fore in the 1960s, "anti-psychiatry" (a term first used by david cooper in 1967) defined a movement that vocally challenged the fundamental claims and practices of mainstream psychiatry. while most of its elements had precedents in earlier decades and centuries, in the 1960s it took on a national and international character, with access to the mass media and incorporating a wide mixture of grassroots activist organizations and prestigious professional bodies. cooper was a south african psychiatrist working in britain. a trained marxist revolutionary, he argued that the political context of psychiatry and its patients had to be highlighted and radically challenged, and warned that the fog of individualized therapeutic language could take away people's ability to see and challenge the bigger social picture. he spoke of having a goal of "non-psychiatry" as well as anti-psychiatry. in the 1960s fresh voices mounted a new challenge to the pretensions of psychiatry as a science and the mental health system as a successful humanitarian enterprise. these voices included: ernest becker, erving goffman, r.d. laing; laing and aaron esterson, thomas scheff, and thomas szasz. their writings, along with others such as articles in the journal the radical therapist, were given the umbrella label "antipsychiatry" despite wide divergences in philosophy. this critical literature, in concert with an activist movement, emphasized the hegemony of medical model psychiatry, its spurious sources of authority, its mystification of human problems, and the more oppressive practices of the mental health system, such as involuntary hospitalisation, drugging, and electroshock. the psychiatrists r d laing (from scotland), theodore lidz (from america), silvano arieti (from italy) and others, argued that "schizophrenia" and psychosis were understandable, and resulted from injuries to the inner-self inflicted by psychologically invasive "schizophrenogenic" parents or others. it was sometimes seen as a transformative state involving an attempt to cope with a sick society. laing, however, partially dissociated himself from his colleague cooper's term "anti-psychiatry". laing had already become a media icon through bestselling books (such as the divided self and the politics of experience) discussing mental distress in an interpersonal existential context; laing was somewhat less focused than his colleague cooper on wider social structures and radical left wing politics, and went on to develop more romanticized or mystical views (as well as equivocating over the use of diagnosis, drugs and commitment). although the movement originally described as anti-psychiatry became associated with the general counter-culture movement of the 1960s, lidz and arieti never became involved in the latter. franco basaglia promoted anti-psychiatry in italy and secured reforms to mental health law there. laing, through the philadelphia association founded with cooper in 1965, set up over 20 therapeutic communities including kingsley hall, where staff and residents theoretically assumed equal status and any medication used was voluntary. non-psychiatric soteria houses, starting in the united states, were also developed as were various ex-patient-led services. psychiatrist thomas szasz argued that "mental illness" is an inherently incoherent combination of a medical and a psychological concept. he opposed the use of psychiatry to forcibly detain, treat, or excuse what he saw as mere deviance from societal norms or moral conduct. as a libertarian, szasz was concerned that such usage undermined personal rights and moral responsibility. adherents of his views referred to "the myth of mental illness", after szasz's controversial 1961 book of that name (based on a paper of the same name that szasz had written in 1957 that, following repeated rejections from psychiatric journals, had been published in the american psychologist in 1960). although widely described as part of the main anti-psychiatry movement, szasz actively rejected the term and its adherents; instead, in 1969, he collaborated with scientology to form the citizens commission on human rights. it was later noted that the view that insanity was not in most or even in any instances a "medical" entity, but a moral issue, was also held by christian scientists and certain protestant fundamentalists, as well as szasz. szasz was not a scientologist himself and was non-religious; he commented frequently on the parallels between religion and psychiatry. erving goffman, gilles deleuze, félix guattari and others criticized the power and role of psychiatry in society, including the use of "total institutions" and the use of models and terms that were seen as stigmatizing. the french sociologist and philosopher foucault, in his 1961 publication madness and civilization: a history of insanity in the age of reason, analyzed how attitudes towards those deemed "insane" had changed as a result of changes in social values. he argued that psychiatry was primarily a tool of social control, based historically on a "great confinement" of the insane and physical punishment and chains, later exchanged in the moral treatment era for psychological oppression and internalized restraint. american sociologist thomas scheff applied labeling theory to psychiatry in 1966 in "being mentally ill". scheff argued that society views certain actions as deviant and, in order to come to terms with and understand these actions, often places the label of mental illness on those who exhibit them. certain expectations are then placed on these individuals and, over time, they unconsciously change their behavior to fulfill them. observation of the abuses of psychiatry in the soviet union in the so-called psikhushka hospitals also led to questioning the validity of the practice of psychiatry in the west. in particular, the diagnosis of many political dissidents with schizophrenia led some to question the general diagnosis and punitive usage of the label schizophrenia. this raised questions as to whether the schizophrenia label and resulting involuntary psychiatric treatment could not have been similarly used in the west to subdue rebellious young people during family conflicts. since 1970 scientologists on an anti-psychiatry demonstration anti-psychiatric movement in poland. new professional approaches were developed as an alternative or reformist complement to psychiatry. the radical therapist, a journal begun in 1971 in north dakota by michael glenn, david bryan, linda bryan, michael galan and sara glenn, challenged the psychotherapy establishment in a number of ways, raising the slogan "therapy means change, not adjustment." it contained articles that challenged the professional mediator approach, advocating instead revolutionary politics and authentic community making. social work, humanistic or existentialist therapies, family therapy, counseling and self-help and clinical psychology developed and sometimes opposed psychiatry. psychoanalysis was increasingly criticized as unscientific or harmful. contrary to the popular view, critics and biographers of freud, such as alice miller, jeffrey masson and louis breger, argued that freud did not grasp the nature of psychological trauma. non-medical collaborative services were developed, for example therapeutic communities or soteria houses. the psychoanalytically trained psychiatrist szasz, although professing fundamental opposition to what he perceives as medicalization and oppressive or excuse-giving "diagnosis" and forced "treatment", was not opposed to other aspects of psychiatry (for example attempts to "cure-heal souls", although he also characterizes this as non-medical). although generally considered anti-psychiatry by others, he sought to dissociate himself politically from a movement and term associated with the radical left-wing. in a 1976 publication "anti-psychiatry: the paradigm of a plundered mind", which has been described as an overtly political condemnation of a wide sweep of people, szasz claimed laing, cooper and all of anti-psychiatry consisted of "self-declared socialists, communists, anarchists or at least anti-capitalists and collectivists". while saying he shared some of their critique of the psychiatric system, szasz compared their views on the social causes of distress/deviance to those of anti-capitalist anti-colonialists who claimed that chilean poverty was due to plundering by american companies, a comment szasz made not long after a cia-backed coup had deposed the democratically elected chilean president and replaced him with pinochet. szasz argued instead that distress/deviance is due to the flaws or failures of individuals in their struggles in life. the anti-psychiatry movement was also being driven by individuals with adverse experiences of psychiatric services. this included those who felt they had been harmed by psychiatry or who felt that they could have been helped more by other approaches, including those compulsorily (including via physical force) admitted to psychiatric institutions and subjected to compulsory medication or procedures.